Provider Demographics
NPI:1780618520
Name:MACOMBER, MELVIN V (PHD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:V
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8789 AUBURN FOLSOM RD
Mailing Address - Street 2:PMB 316 SUITE C
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6287
Mailing Address - Country:US
Mailing Address - Phone:916-652-7014
Mailing Address - Fax:916-652-7014
Practice Address - Street 1:8789 AUBURN FOLSOM RD
Practice Address - Street 2:PMB 316 SUITE C
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6287
Practice Address - Country:US
Practice Address - Phone:916-652-7014
Practice Address - Fax:916-652-7014
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY10145171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor