MEDICARE: KIMBERLY MELGAR

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
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1689479792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MELGAR

Provider Business Mailing Address
First Line	:	2225 38TH AVE APT C
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3741
Country	:	US
Telephone Number	:	510-827-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 38TH AVE APT C
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3741
Country	:	US
Telephone Number	:	510-827-5252
Fax Number	:

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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Directions to “ KIMBERLY MELGAR ” Practice Location

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