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General NPI Number Information
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NPI Number | 1881706521
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Entity Type | Organization
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Legal Business Name | MELODIA AQUINO-ELIAZO MD CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 1045 R ST
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City | FRESNO
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State | CA
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Zip | 93721-1312
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Country | US
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Telephone | 559-268-9737
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Fax | 559-268-0279
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Provider Business Mailing Address
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Address Line | 1045 R ST
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City | FRESNO
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State | CA
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Zip | 93721-1312
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Country | US
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Telephone | 559-268-9737
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Fax | 559-268-0279
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Authorized Official
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Title or Position | M.D./PRESIDENT
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Name | MELODIA AQUINO ELIAZO
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Credential | M.D.
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Telephone | 559-268-9737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A42414
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License Number State | CA
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