Basic Information
Provider Information | |||||||||
NPI: | 1184624744 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ASTRAN | ||||||||
FirstName: | MELINDA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1200 W MOHAVE RD | ||||||||
Address2: |   | ||||||||
City: | PARKER | ||||||||
State: | AZ | ||||||||
PostalCode: | 853446349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9286699201 | ||||||||
FaxNumber: | 9286697404 | ||||||||
Practice Location | |||||||||
Address1: | 4058 WILLOWS RD | ||||||||
Address2: |   | ||||||||
City: | ALPINE | ||||||||
State: | CA | ||||||||
PostalCode: | 919011668 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6194451188 | ||||||||
FaxNumber: | 6196593140 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 10/08/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34058 | AZ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | K7650 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | ME88278 | FL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | C163169 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 970089 | 05 | AZ |   | MEDICAID | 1073680468 | 01 |   | PRACTICE NPI | OTHER | 34058 | 01 | AZ | MEDICAL LICENSE | OTHER | P00296621 | 01 |   | RAILROAD MEDICARE | OTHER |