1720321755 NPI number — DR. MELISSA ANN NARDI D.O.

Table of content: DR. MELISSA ANN NARDI D.O. (NPI 1720321755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720321755 NPI number — DR. MELISSA ANN NARDI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARDI
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720321755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4077 FIFTH AVE
Provider Second Line Business Mailing Address:
MER 127
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-294-8111
Provider Business Mailing Address Fax Number:
619-686-3440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4077 FIFTH AVE
Provider Second Line Business Practice Location Address:
MER 127
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-924-8111
Provider Business Practice Location Address Fax Number:
619-686-3440
Provider Enumeration Date:
03/27/2013

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: 207R00000X , with the licence number:  20A13524 , 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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