Healthcare Provider Details

I. General information

NPI: 1144101213
Provider Name (Legal Business Name): MELODY MYVETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BAYONET CIR
MARINA CA
93933-4600
US

IV. Provider business mailing address

617 BAYONET CIR
MARINA CA
93933-4600
US

V. Phone/Fax

Practice location:
  • Phone: 831-384-7251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: