MEDICARE: MELISSA E. HURD 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	207Q00000X	Family Medicine Physician	A61672	CA

General Provider Information

NPI Number	:	1487643698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E. HURD M.D.

Provider Business Mailing Address
First Line	:	161 THUNDER DR
Second Line	:	STE 103
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-758-1988
Fax Number	:	760-758-0922

Provider Business Practice Location Address
First Line	:	161 THUNDER DR
Second Line	:	STE 103
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-758-1988
Fax Number	:	760-758-0922

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	01/26/2010

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