Healthcare Provider Details

I. General information

NPI: 1164112496
Provider Name (Legal Business Name): MELISSA QUAID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

1321 40TH ST APT 230
EMERYVILLE CA
94608-4802
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number95323762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95323762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: