Healthcare Provider Details

I. General information

NPI: 1487643698
Provider Name (Legal Business Name): MELISSA E. HURD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THUNDER DR STE 103
VISTA CA
92083-6016
US

IV. Provider business mailing address

161 THUNDER DR STE 103
VISTA CA
92083-6016
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1988
  • Fax: 760-758-0922
Mailing address:
  • Phone: 760-758-1988
  • Fax: 760-758-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA61672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: