Basic Information
| Provider Information | |||||||||
| NPI: | 1053037614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAGEL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39899 BALENTINE DR STE 128 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945605361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509316300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1710 S AMPHLETT BLVD STE 220 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944022705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507624365 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.