Provider Demographics
NPI:1881706521
Name:MELODIA AQUINO-ELIAZO MD CORPORATION
Entity type:Organization
Organization Name:MELODIA AQUINO-ELIAZO MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODIA
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:ELIAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-268-9737
Mailing Address - Street 1:1045 R ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1312
Mailing Address - Country:US
Mailing Address - Phone:559-268-9737
Mailing Address - Fax:559-268-0279
Practice Address - Street 1:1045 R ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1312
Practice Address - Country:US
Practice Address - Phone:559-268-9737
Practice Address - Fax:559-268-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42414261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A424141Medicaid
CA00A424141Medicaid
CAA29577Medicare UPIN