Healthcare Provider Details

I. General information

NPI: 1790880300
Provider Name (Legal Business Name): MELANIE ANNE DOTY NP MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH CENT 1156 HIGH STREET
SANTA ROSA CA
95064
US

IV. Provider business mailing address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 831-459-2211
  • Fax: 831-459-3546
Mailing address:
  • Phone: 707-571-3188
  • Fax: 707-571-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPC #8930
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 307291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: