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General NPI Number Information
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NPI Number | 1972389948
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Entity Type | Individual
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Provider Name | MELISSA DE ASIS DEOCAMPO- ESCALANTE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 3569 ROUND BARN CIR
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City | SANTA ROSA
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State | CA
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Zip | 95403-5781
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Country | US
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Telephone | 510-375-3365
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Fax |
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Provider Business Mailing Address
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Address Line | 5822 KITTYHAWK PL
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City | ROHNERT PARK
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State | CA
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Zip | 94928-5068
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95027367
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F08230704
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License Number State | CA
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