Healthcare Provider Details

I. General information

NPI: 1104223296
Provider Name (Legal Business Name): MELANIE T NORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE T PERERA

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 DISTEL CIR
LOS ALTOS CA
94022-1404
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 650-254-5200
  • Fax:
Mailing address:
  • Phone: 650-254-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: