Provider Demographics
NPI:1912526807
Name:MELARA MOJICA, SERGIO JOSUE (DPM)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:JOSUE
Last Name:MELARA MOJICA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6304
Mailing Address - Country:US
Mailing Address - Phone:559-890-3234
Mailing Address - Fax:
Practice Address - Street 1:2131 HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6304
Practice Address - Country:US
Practice Address - Phone:559-890-3234
Practice Address - Fax:559-890-3230
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5942213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery