Healthcare Provider Details

I. General information

NPI: 1477213221
Provider Name (Legal Business Name): MELANIE JULIA HEERS SUOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 CROW CANYON PL
SAN RAMON CA
94583-1359
US

IV. Provider business mailing address

3151 CROW CANYON PL
SAN RAMON CA
94583-1359
US

V. Phone/Fax

Practice location:
  • Phone: 925-202-0341
  • Fax:
Mailing address:
  • Phone: 925-202-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: