Provider Demographics
NPI:1982740932
Name:VANCE TRUP, MELINDA RUTH (MS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:RUTH
Last Name:VANCE TRUP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 ENGLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2232
Mailing Address - Country:US
Mailing Address - Phone:916-482-2273
Mailing Address - Fax:916-974-2936
Practice Address - Street 1:4748 ENGLE RD STE 107
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2232
Practice Address - Country:US
Practice Address - Phone:916-482-2273
Practice Address - Fax:916-974-2936
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2740237700000X
CAAU1245231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54183ZOtherBLUE SHIELD
CAZZZ56178ZOtherBLUE SHIELD
CA171689100OtherDEPT OF LABOR
CA640003571OtherRAILROAD MEDICARE
CAAU0001245Medicaid