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General NPI Number Information
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NPI Number | 1700147352
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Entity Type | Individual
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Provider Name | MELISSA AMORITA BIEWENGA MD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 4405 VANDEVER AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-3315
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Country | US
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Telephone | 800-290-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 VANDEVER AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-3315
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0071558
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A122243
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License Number State | CA
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