Basic Information
| Provider Information | |||||||||
| NPI: | 1134268998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADLER VENTURI | ||||||||
| FirstName: | MELODIE | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2970 HILLTOP MALL RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948061949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102228000 | ||||||||
| FaxNumber: | 5102222690 | ||||||||
| Practice Location | |||||||||
| Address1: | 2970 HILLTOP MALL RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948061949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102228000 | ||||||||
| FaxNumber: | 5102222690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 10663 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.