Healthcare Provider Details

I. General information

NPI: 1265167555
Provider Name (Legal Business Name): MELISSA HA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27710 JEFFERSON AVE STE 200
TEMECULA CA
92590-4604
US

IV. Provider business mailing address

2006 MIRASOL ST
SANTA ANA CA
92705-7807
US

V. Phone/Fax

Practice location:
  • Phone: 888-491-0049
  • Fax: 888-509-0937
Mailing address:
  • Phone: 714-653-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: