1518502319 NPI number — MELISSA ANNE MAXWELL PMHNP - BC

Table of content: JESSICA DELILA MARTINEZ (NPI 1649784323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518502319 NPI number — MELISSA ANNE MAXWELL PMHNP - BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
MELISSA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP - BC
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:
1518502319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 POST ST STE 1043
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94102-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-282-1778
Provider Business Mailing Address Fax Number:
415-296-5299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 POST ST STE 1043
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94102-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-282-1778
Provider Business Practice Location Address Fax Number:
415-296-5299
Provider Enumeration Date:
11/15/2019

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: 363LP0808X , with the licence number:  95013526 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 28200431A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 71009757B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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