Healthcare Provider Details

I. General information

NPI: 1093385775
Provider Name (Legal Business Name): MELINA LEONE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 UNIVERSITY AVE STE A
LA MESA CA
91942-5963
US

IV. Provider business mailing address

927 F AVE
CORONADO CA
92118-2509
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-2184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95017025
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: