Healthcare Provider Details

I. General information

NPI: 1144882622
Provider Name (Legal Business Name): MELISSA DOMIANO RATSAMY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD STE 100
SAN DIEGO CA
92120-3425
US

IV. Provider business mailing address

6160 MISSION GORGE RD STE 100
SAN DIEGO CA
92120-3425
US

V. Phone/Fax

Practice location:
  • Phone: 619-481-3790
  • Fax: 619-481-3797
Mailing address:
  • Phone: 619-481-3790
  • Fax: 619-481-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number1144882622
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number1144882622
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: