Provider Demographics
NPI:1114235280
Name:RICOSSA, MELINDA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ANN
Last Name:RICOSSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ALAMEDA
Mailing Address - Street 2:STE 240
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1269
Mailing Address - Country:US
Mailing Address - Phone:650-372-8573
Mailing Address - Fax:650-522-9830
Practice Address - Street 1:2000 ALAMEDA
Practice Address - Street 2:STE 240
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1269
Practice Address - Country:US
Practice Address - Phone:650-372-8573
Practice Address - Fax:650-522-9830
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN552003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse