Provider Information for 1790335636
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MELISSA L HERCEG
Sex: Female
NPI: 1790335636
Last Updated: 2023-11-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790335636 | ||||||||||||||
| Enumeration Date | 2019-09-12 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1555 SOQUEL DRIVE MATERNAL CHILD HEALTH SOCIAL WORKER SANTA CRUZ, CA 95065-1707 United States Phone: 831-840-5914 | Fax: | ||||||||||||||
| Primary Practice Address | 1555 SOQUEL DR SANTA CRUZ, CA 95065-1705 United States Phone: 831-840-5914 | Fax: | ||||||||||||||
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