Provider Demographics
NPI:1134268998
Name:RADLER VENTURI, MELODIE V (PA)
Entity type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:V
Last Name:RADLER VENTURI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2970 HILLTOP MALL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1949
Mailing Address - Country:US
Mailing Address - Phone:510-222-8000
Mailing Address - Fax:510-222-2690
Practice Address - Street 1:2970 HILLTOP MALL RD STE 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1949
Practice Address - Country:US
Practice Address - Phone:510-222-8000
Practice Address - Fax:510-222-2690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10663363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical