Healthcare Provider Details

I. General information

NPI: 1912427386
Provider Name (Legal Business Name): MELINDA EHREN KRATZIG ARNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA CATHERINE EHREN

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEDICAL CENTER DR
MURRIETA CA
92562-5965
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-6124
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number60768766
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP95013757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: