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General NPI Number Information
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NPI Number | 1881672517
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Entity Type | Individual
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Provider Name | MELODEE LUBAG MILLARE PA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 73 W MARCH LN SUITE A
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City | STOCKTON
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State | CA
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Zip | 95207-5726
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Country | US
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Telephone | 209-957-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 10326 TANK HOUSE DR
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City | STOCKTON
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State | CA
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Zip | 95209-4337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17732
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License Number State | CA
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