Provider Demographics
NPI:1912526807
Name:MELARA MOJICA, SERGIO JOSUE (DPM)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:JOSUE
Last Name:MELARA MOJICA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MEDICAL CENTER DR E STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6811
Mailing Address - Country:US
Mailing Address - Phone:559-298-7533
Mailing Address - Fax:
Practice Address - Street 1:724 MEDICAL CENTER DR E STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6811
Practice Address - Country:US
Practice Address - Phone:559-298-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5942213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery