Healthcare Provider Details

I. General information

NPI: 1861798225
Provider Name (Legal Business Name): MELISSA MAY HENDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 13TH AVENUE
LUCERNE CA
95458-0000
US

IV. Provider business mailing address

6302 THIRTEENTH AVENUE
LUCERNE CA
95458
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9101
  • Fax: 707-274-9102
Mailing address:
  • Phone: 707-274-9101
  • Fax: 707-274-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: