Healthcare Provider Details

I. General information

NPI: 1376634568
Provider Name (Legal Business Name): MELISSA CARDIASMENOS GONDEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MELISSA MARIA CARDIASMENOS

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OFARRELL ST
SAN FRANCISCO CA
94115-3357
US

IV. Provider business mailing address

2200 OFARRELL ST
SAN FRANCISCO CA
94115-3357
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-4798
  • Fax: 415-833-4201
Mailing address:
  • Phone: 415-833-4798
  • Fax: 415-833-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP7919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: