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General NPI Number Information
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NPI Number | 1679764179
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Entity Type | Individual
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Provider Name | MELISSA KAGNOFF M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 6699 ALVARADO RD SUITE 2301
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City | SAN DIEGO
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State | CA
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Zip | 92120-5244
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Country | US
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Telephone | 619-582-2595
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Fax | 619-229-8006
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 928-759-5874
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Fax | 928-458-2039
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 27100
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A121332
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 58383
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 66706
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A121332
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License Number State | CA
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