Provider Demographics
NPI:1558026112
Name:VILORIA, MELISSA-DARLENE RICO
Entity Type:Individual
Prefix:
First Name:MELISSA-DARLENE
Middle Name:RICO
Last Name:VILORIA
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 1:255 EL CAMINO REAL APT 101
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5142
Mailing Address - Country:US
Mailing Address - Phone:707-290-8507
Mailing Address - Fax:
Practice Address - Street 1:2201 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1820
Practice Address - Country:US
Practice Address - Phone:650-910-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner