Basic Information
| Provider Information | |||||||||
| NPI: | 1396975199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRANGE | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 DOYLE PARK DR | ||||||||
| Address2: | SUITE G04 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073038360 | ||||||||
| FaxNumber: | 7073038361 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 DOYLE PARK DR | ||||||||
| Address2: | SUITE G04 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073038360 | ||||||||
| FaxNumber: | 7073038361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34.010235 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 20A12020 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.