Healthcare Provider Details

I. General information

NPI: 1730817289
Provider Name (Legal Business Name): MELISSA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 3RD ST FL 2
SAN FRANCISCO CA
94103-3103
US

IV. Provider business mailing address

4274 LAS FELIZ CT
UNION CITY CA
94587-3813
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: