Provider Demographics
NPI:1144575101
Name:AZARRAGA, MELISSA CRUZ
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRUZ
Last Name:AZARRAGA
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 1:2485 EL CAMINO REAL
Mailing Address - Street 2:T-0321
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2849
Mailing Address - Country:US
Mailing Address - Phone:650-549-0000
Mailing Address - Fax:650-480-5816
Practice Address - Street 1:2485 EL CAMINO REAL
Practice Address - Street 2:T-0321
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2849
Practice Address - Country:US
Practice Address - Phone:650-549-0000
Practice Address - Fax:650-480-5816
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist