Provider Demographics
NPI:1720226962
Name:MARGOLIS, MELISSA A (LAC MSTCM)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:LAC MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5222
Mailing Address - Country:US
Mailing Address - Phone:415-570-1084
Mailing Address - Fax:
Practice Address - Street 1:2719 ENCINAL AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4784
Practice Address - Country:US
Practice Address - Phone:415-570-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10120171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist