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General NPI Number Information
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NPI Number | 1134417447
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Entity Type | Individual
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Provider Name | MELANIE DYAN JOHANSSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 6939 SUNRISE BLVD STE 106
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-3153
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Country | US
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Telephone | 916-352-7777
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Fax | 877-354-4771
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Provider Business Mailing Address
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Address Line | 6939 SUNRISE BLVD STE 106
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-3153
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Country | US
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Telephone | 916-352-7777
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Fax | 877-354-4771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | C183026
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License Number State | CA
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