Provider Demographics
NPI:1285135038
Name:BITH-MELANDER, POLLIE DARARITH
Entity type:Individual
Prefix:
First Name:POLLIE
Middle Name:DARARITH
Last Name:BITH-MELANDER
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 1:652 VALLE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1922
Mailing Address - Country:US
Mailing Address - Phone:510-499-6925
Mailing Address - Fax:
Practice Address - Street 1:960 10TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3106
Practice Address - Country:US
Practice Address - Phone:510-874-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC7062342OtherDRIVER LICENSE