Basic Information
Provider Information
NPI: 1285959718
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCABE
FirstName: MELISSA
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: MD, MSCR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MILLER
OtherFirstName: MELISSA
OtherMiddleName: D
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 11234 ANDERSON ST
Address2: MC-2532
City: LOMA LINDA
State: CA
PostalCode: 92354
CountryCode: US
TelephoneNumber: 9095584000
FaxNumber:  
Practice Location
Address1: 11234 ANDERSON ST
Address2: MC-2532
City: LOMA LINDA
State: CA
PostalCode: 92354
CountryCode: US
TelephoneNumber: 9095584000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/26/2010
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA119032CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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