Provider Demographics
NPI:1164292009
Name:RAMBO, MELISSA KAYE (DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAYE
Last Name:RAMBO
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7330
Mailing Address - Country:US
Mailing Address - Phone:480-980-5909
Mailing Address - Fax:480-980-5909
Practice Address - Street 1:1948 E FREMONT DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7330
Practice Address - Country:US
Practice Address - Phone:480-980-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist