Healthcare Provider Details

I. General information

NPI: 1396975199
Provider Name (Legal Business Name): MELISSA STRANGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR SUITE G04
SANTA ROSA CA
95405-4558
US

IV. Provider business mailing address

500 DOYLE PARK DR SUITE G04
SANTA ROSA CA
95405-4558
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-8360
  • Fax: 707-303-8361
Mailing address:
  • Phone: 707-303-8360
  • Fax: 707-303-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.010235
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A12020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: