Provider Demographics
NPI:1952699738
Name:BROOKS, MELAINE RACHELLE (RD)
Entity type:Individual
Prefix:MS
First Name:MELAINE
Middle Name:RACHELLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 PEPPER DR APT C
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-7112
Mailing Address - Country:US
Mailing Address - Phone:559-904-2793
Mailing Address - Fax:
Practice Address - Street 1:310 N IRWIN ST
Practice Address - Street 2:SUITE 21
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4479
Practice Address - Country:US
Practice Address - Phone:559-904-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819308133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal