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General NPI Number Information
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NPI Number | 1942650171
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Entity Type | Individual
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Provider Name | MELISSA PATRICE GORDON LVN
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Gender | Female
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Dates
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Enumeration Date | 06/19/2016
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 2822 MONROE ST
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City | RIVERSIDE
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State | CA
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Zip | 92504-4284
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Country | US
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Telephone | 860-997-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 6242 MULAN ST
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City | EASTVALE
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State | CA
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Zip | 92880-0790
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Country | US
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Telephone | 860-997-1747
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 273053
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License Number State | CA
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