Provider Demographics
NPI:1093059800
Name:BRILLANTES, MELISSA (LVN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRILLANTES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4208
Mailing Address - Country:US
Mailing Address - Phone:707-315-1989
Mailing Address - Fax:
Practice Address - Street 1:6124 34TH ST
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4208
Practice Address - Country:US
Practice Address - Phone:707-315-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN165026164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse