Healthcare Provider Details

I. General information

NPI: 1861949364
Provider Name (Legal Business Name): MELANIE LYNNE SPANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE L RASMUS PAC

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10538 MISSION GORGE RD STE 100
SANTEE CA
92071
US

IV. Provider business mailing address

10538 MISSION GORGE RD STE 100
SANTEE CA
92071-3154
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number23.003660
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: