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General NPI Number Information
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NPI Number | 1689288136
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Entity Type | Individual
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Provider Name | MELISSA EILEEN FITZGIBBON MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 03/18/2023
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Provider Practice Location Address
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Address Line | 9550 CARMEL MOUNTAIN RD
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City | SAN DIEGO
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State | CA
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Zip | 92129-2799
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Country | US
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Telephone | 858-484-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 1259 CALLE ULTIMO
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City | OCEANSIDE
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State | CA
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Zip | 92056-5633
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Country | US
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Telephone | 760-994-3820
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 13005003-4810
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RTO000553
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License Number State | PA
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