Healthcare Provider Details

I. General information

NPI: 1154518488
Provider Name (Legal Business Name): MELISSA M HOLMES I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MARTIN LUTHER KING JR BLVD
SACRAMENTO CA
95817-3648
US

IV. Provider business mailing address

3415 MARTIN LUTHER KING JR BLVD
SACRAMENTO CA
95817-3648
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-2995
  • Fax: 916-875-2921
Mailing address:
  • Phone: 916-875-2995
  • Fax: 916-875-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: