Healthcare Provider Details

I. General information

NPI: 1033388269
Provider Name (Legal Business Name): MELICENT CLARE PECK M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE S-380, BOX 0654
SAN FRANCISCO CA
94143-0654
US

IV. Provider business mailing address

513 PARNASSUS AVE S-380, BOX 0654
SAN FRANCISCO CA
94143-0654
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9362
  • Fax:
Mailing address:
  • Phone: 415-476-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA105023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: