Provider Information for 1164730560
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MELANIE LYNN FIKSE
Sex: Female
NPI: 1164730560
Last Updated: 2023-11-25
Certification Date: 2023-11-25
Certification Date: 2023-11-25
Details
Name | Value | ||||||||||||
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NPI | 1164730560 | ||||||||||||
Enumeration Date | 2010-09-20 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 412 E MAIN ST STE F GRASS VALLEY, CA 95945-6533 United States Phone: 415-490-7510 | Fax: | ||||||||||||
Primary Practice Address | 412 E MAIN ST STE F GRASS VALLEY, CA 95945-6533 United States Phone: 415-490-7510 | Fax: | ||||||||||||
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