Provider Demographics
NPI:1780946012
Name:AGBUYA-FLORES, MELODY (OD)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:AGBUYA-FLORES
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 1:1665 DOMINICAN WAY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1580
Mailing Address - Country:US
Mailing Address - Phone:831-476-1298
Mailing Address - Fax:
Practice Address - Street 1:1665 DOMINICAN WAY
Practice Address - Street 2:SUITE 122
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1580
Practice Address - Country:US
Practice Address - Phone:831-476-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14419TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist