Provider Demographics
NPI:1326030867
Name:KOMROSKY, MELISSA CLARICE (NP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CLARICE
Last Name:KOMROSKY
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:16770 CABERNET CIR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7081
Mailing Address - Country:US
Mailing Address - Phone:650-224-4854
Mailing Address - Fax:408-782-8780
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-885-5167
Practice Address - Fax:408-885-5169
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CARN 611446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ29726Medicare UPIN
CAZZZ32707ZMedicare PIN