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General NPI Number Information
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NPI Number | 1225668205
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Entity Type | Individual
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Provider Name | MELISSA HISAKO REAGAN
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Gender | Female
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 1261 TRAVIS BLVD STE 100
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City | FAIRFIELD
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State | CA
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Zip | 94533-4804
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Country | US
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Telephone | 707-422-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 207 BRIDGEWATER CIR
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City | SUISUN CITY
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State | CA
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Zip | 94585-1774
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Country | US
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Telephone | 707-389-6421
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | Z9T4J4S3
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License Number State | CA
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