Healthcare Provider Details

I. General information

NPI: 1700556636
Provider Name (Legal Business Name): MELYSSA RUTH HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELYSSA BROWNING WALDNER NP

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 5TH AVE STE 110
SAN DIEGO CA
92103-3122
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026460
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61195531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: