=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063224392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELINDA BELGRAVE MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 SHEPARD DR STE 102
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-7016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-928-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 SHEPARD DR STE 102
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-7016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-928-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. MELINDA C BELGRAVE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-928-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------