1114196425 NPI number — MISS MELISA MARIE HILL RN, MSN, CPNP

Table of content: MISS MELISA MARIE HILL RN, MSN, CPNP (NPI 1114196425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114196425 NPI number — MISS MELISA MARIE HILL RN, MSN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
MELISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114196425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12200 MONTECITO RD
Provider Second Line Business Mailing Address:
UNIT B106
Provider Business Mailing Address City Name:
SEAL BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90740-2651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-818-5240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 S MAIN ST
Provider Second Line Business Practice Location Address:
2PICU
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-532-8421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  607923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 16890 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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