Healthcare Provider Details

I. General information

NPI: 1093274144
Provider Name (Legal Business Name): MELISSA ELAINE BERGES MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE DEPT OF
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-0735
  • 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: