Basic Information
| Provider Information | |||||||||
| NPI: | 1467666362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORENCIA | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | SANDOVAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2748 MILTON WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983549379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539225262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2748 MILTON WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983549379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539225262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00047522 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8867415 | 01 | WA | MEDICARE | OTHER | 8488876 | 05 | WA | MEDICAID | 1044352 | 05 | WA | MEDICAID | 0224036 | 01 | WA | L&I | OTHER |