Provider Demographics
NPI:1154986438
Name:TARANGO, MELISSA CRUZ
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRUZ
Last Name:TARANGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 64TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2009
Mailing Address - Country:US
Mailing Address - Phone:510-677-1673
Mailing Address - Fax:
Practice Address - Street 1:1625 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3219
Practice Address - Country:US
Practice Address - Phone:415-822-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker