MEDICARE: MELANIE DYAN JOHANSSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	C183026	CA

General Provider Information

NPI Number	:	1134417447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE DYAN JOHANSSON M.D.

Provider Business Mailing Address
First Line	:	6939 SUNRISE BLVD STE 106
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3153
Country	:	US
Telephone Number	:	916-352-7777
Fax Number	:	877-354-4771

Provider Business Practice Location Address
First Line	:	6939 SUNRISE BLVD STE 106
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3153
Country	:	US
Telephone Number	:	916-352-7777
Fax Number	:	877-354-4771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	05/01/2025

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