1124861893 NPI number — MELISSA K MCGEORGE DACM, L.AC.

Table of content: MELISSA K MCGEORGE DACM, L.AC. (NPI 1124861893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124861893 NPI number — MELISSA K MCGEORGE DACM, L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGEORGE
Provider First Name:
MELISSA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DACM, L.AC.
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:
1124861893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1654 CAMERON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMON GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91945-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-262-1951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4514 BONITA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91902-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-470-4714
Provider Business Practice Location Address Fax Number:
619-470-3452
Provider Enumeration Date:
06/18/2024

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: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: 19993 , 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)





Copyright © 2007-2025 www.npivalidator.com