Healthcare Provider Details

I. General information

NPI: 1760627194
Provider Name (Legal Business Name): MELISSA XIA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 HAZELWOOD DR
SOUTH SAN FRANCISCO CA
94080-5806
US

IV. Provider business mailing address

223 HAZELWOOD DR
SOUTH SAN FRANCISCO CA
94080-5806
US

V. Phone/Fax

Practice location:
  • Phone: 650-888-2553
  • Fax:
Mailing address:
  • Phone: 650-888-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number973414
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: