Provider Demographics
NPI:1194722702
Name:MYERS, MELINDA LENORE (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:LENORE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 YGNACIO VALLEY RD
Mailing Address - Street 2:STE 206
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3125
Mailing Address - Country:US
Mailing Address - Phone:925-932-1555
Mailing Address - Fax:925-932-1625
Practice Address - Street 1:1776 YGNACIO VALLEY RD
Practice Address - Street 2:STE 206
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3125
Practice Address - Country:US
Practice Address - Phone:925-932-1555
Practice Address - Fax:925-932-1625
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G30801Medicare ID - Type Unspecified
CAE35429Medicare UPIN