Provider Demographics
NPI:1518283795
Name:SANFORD, MELISSA TALBERT (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TALBERT
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ASHLEY
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 N OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2237
Mailing Address - Country:US
Mailing Address - Phone:210-621-4093
Mailing Address - Fax:
Practice Address - Street 1:201 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2237
Practice Address - Country:US
Practice Address - Phone:210-621-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4875208800000X, 2088F0040X
CAA119346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology