Healthcare Provider Details

I. General information

NPI: 1093749004
Provider Name (Legal Business Name): MELISSA KAY CROCHET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LOS GAMOS DR STE 300
SAN RAFAEL CA
94903-1850
US

IV. Provider business mailing address

1650 LOS GAMOS DR STE 300
SAN RAFAEL CA
94903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-4440
  • Fax: 415-492-6215
Mailing address:
  • Phone: 415-444-4440
  • Fax: 415-492-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK4400
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA53333
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberK4400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: