Provider Demographics
NPI:1932299328
Name:MELENDEZ-NGO, ANDREA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MELENDEZ-NGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4454
Mailing Address - Country:US
Mailing Address - Phone:925-447-3883
Mailing Address - Fax:925-447-2957
Practice Address - Street 1:1800 FOURTH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4454
Practice Address - Country:US
Practice Address - Phone:925-447-3883
Practice Address - Fax:925-447-2957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12614T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126140Medicare PIN
CAV12293Medicare UPIN