Healthcare Provider Details

I. General information

NPI: 1093291288
Provider Name (Legal Business Name): MELISSA HAGADORN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 W LINCOLN AVE STE 100
ANAHEIM CA
92801-6022
US

IV. Provider business mailing address

5842 TERRIER DR
HUNTINGTON BEACH CA
92649-4946
US

V. Phone/Fax

Practice location:
  • Phone: 800-881-5101
  • Fax:
Mailing address:
  • Phone: 714-840-1486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: