Healthcare Provider Details

I. General information

NPI: 1578499083
Provider Name (Legal Business Name): MELANI LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GLEN CANYON RD
SCOTTS VALLEY CA
95066-4923
US

IV. Provider business mailing address

3600 GLEN CANYON RD
SCOTTS VALLEY CA
95066-4923
US

V. Phone/Fax

Practice location:
  • Phone: 831-295-0383
  • Fax: 831-295-0383
Mailing address:
  • Phone: 831-295-0383
  • Fax: 831-295-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-BZORFJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: