Provider Demographics
NPI:1184763575
Name:AGNESS, MELISA MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISA
Middle Name:MOORE
Last Name:AGNESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LITTON DR STE 208
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5079
Mailing Address - Country:US
Mailing Address - Phone:530-273-2720
Mailing Address - Fax:530-273-2770
Practice Address - Street 1:140 LITTON DR STE 208
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5079
Practice Address - Country:US
Practice Address - Phone:530-273-2720
Practice Address - Fax:530-273-2770
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA455122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology