Provider Demographics
NPI:1225564008
Name:MELO, ELIZABETH ANN SILVA
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN SILVA
Last Name:MELO
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 1:562 NORTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-9675
Mailing Address - Country:US
Mailing Address - Phone:559-707-1544
Mailing Address - Fax:
Practice Address - Street 1:562 NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-9675
Practice Address - Country:US
Practice Address - Phone:559-707-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000008505405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional