Basic Information
| Provider Information | |||||||||
| NPI: | 1497074108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POONACHA | ||||||||
| FirstName: | MELANIA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1595 SOQUEL DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314751111 | ||||||||
| FaxNumber: | 8314765020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME114641 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 130281 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | ME114641 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 130281 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 130281 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | ME114641 | 01 | FL | FL MEDICAL LICENSE | OTHER |