Healthcare Provider Details

I. General information

NPI: 1316268261
Provider Name (Legal Business Name): MELISSA TRAN-CHAMBLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA TRAN

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071
US

IV. Provider business mailing address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3040
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax: 619-312-2661
Mailing address:
  • Phone: 619-383-6868
  • Fax: 619-312-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: