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NPI Code Detail

MEDICARE: MS. MELIA FORMENTO APRN

MEDICARE: MS. MELIA FORMENTO APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner726016CA

General Provider Information

NPI Number : 1205878493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELIA FORMENTO APRN
Provider Business Mailing Address
First Line : 3030 EXPLORER DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95827-2728
Country : US
Telephone Number : 916-642-1885
Fax Number :
Provider Business Practice Location Address
First Line : 3030 EXPLORER DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95827-2728
Country : US
Telephone Number : 916-642-1885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 05/21/2019

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