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General NPI Number Information
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NPI Number | 1164716007
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Entity Type | Individual
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Provider Name | MS. MELISSA ANN PAYNE
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Gender | Female
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 123 N E ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1921
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Country | US
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Telephone | 909-884-6677
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Fax | 909-884-9496
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Provider Business Mailing Address
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Address Line | 331 CAJON ST APT B
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City | REDLANDS
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State | CA
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Zip | 92373-5964
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Country | US
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Telephone | 909-496-2978
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0561780
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License Number State | CA
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