Provider Demographics
NPI:1811154917
Name:MELTON, DANIEL ROBERT (LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:MELTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17630 DE WITT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4008
Mailing Address - Country:US
Mailing Address - Phone:858-354-5355
Mailing Address - Fax:
Practice Address - Street 1:17660 MONTEREY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3601
Practice Address - Country:US
Practice Address - Phone:408-778-7959
Practice Address - Fax:408-889-4344
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist