Healthcare Provider Details

I. General information

NPI: 1710954581
Provider Name (Legal Business Name): MELINDA ELLIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 240
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-8820
  • Fax: 210-702-4340
Mailing address:
  • Phone: 210-358-9174
  • Fax: 210-358-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: