Healthcare Provider Details

I. General information

NPI: 1427874320
Provider Name (Legal Business Name): MELINDA TRACY BS, RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17803 IMPERIAL HWY
YORBA LINDA CA
92886-2362
US

IV. Provider business mailing address

1817 AVENIDA DEL DIABLO
ESCONDIDO CA
92029-3112
US

V. Phone/Fax

Practice location:
  • Phone: 714-844-0967
  • Fax:
Mailing address:
  • Phone: 760-580-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number42430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: