Provider Demographics
NPI:1477877066
Name:LARES, MELISSA BURCHARD (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BURCHARD
Last Name:LARES
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 1:2725 CAPITOL AVE DEPT 304
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6006
Mailing Address - Country:US
Mailing Address - Phone:916-262-9414
Mailing Address - Fax:
Practice Address - Street 1:2725 CAPITOL AVE DEPT 304
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6006
Practice Address - Country:US
Practice Address - Phone:916-262-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118921207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology