Healthcare Provider Details

I. General information

NPI: 1831581586
Provider Name (Legal Business Name): MELISSA CHRISTINE GRUNT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CHRISTINE BETANCOURT PNP

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 250
SANTA BARBARA CA
93111-2466
US

IV. Provider business mailing address

5333 HOLLISTER AVE STE 250
SANTA BARBARA CA
93111-2466
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-4240
  • Fax:
Mailing address:
  • Phone: 805-879-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP95002056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: