MEDICARE: ERNESTO MELARA RODRIGUEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	CA
2	106H00000X	Marriage & Family Therapist
3	172V00000X	Community Health Worker	CA

General Provider Information

NPI Number	:	1598296790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO MELARA RODRIGUEZ

Provider Business Mailing Address
First Line	:	9343 TECH CENTER DR STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2592
Country	:	US
Telephone Number	:	916-388-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 MADISON AVE
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5069
Country	:	US
Telephone Number	:	916-840-1537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/07/2024

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