Healthcare Provider Details

I. General information

NPI: 1043502677
Provider Name (Legal Business Name): MELISSA LEIGH DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 01/25/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MAGNOLIA AVENUE SUITE A
CHICO CA
95926
US

IV. Provider business mailing address

1390 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-5080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number16459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: