Provider Demographics
NPI:1467666362
Name:ORENCIA, MELANIE SANDOVAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SANDOVAL
Last Name:ORENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9379
Mailing Address - Country:US
Mailing Address - Phone:253-922-5262
Mailing Address - Fax:
Practice Address - Street 1:2748 MILTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9379
Practice Address - Country:US
Practice Address - Phone:253-922-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8867415OtherMEDICARE
WA8488876Medicaid
WA1044352Medicaid
WA0224036OtherL&I