Provider Demographics
NPI:1033991682
Name:MELANCENTRIC
Entity Type:Organization
Organization Name:MELANCENTRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FULL SPECTRUM DOULA
Authorized Official - Prefix:
Authorized Official - First Name:NADJA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-251-6011
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-0463
Mailing Address - Country:US
Mailing Address - Phone:916-251-6811
Mailing Address - Fax:
Practice Address - Street 1:6113 NORTHERN LIGHTS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4235
Practice Address - Country:US
Practice Address - Phone:916-251-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty