Provider Demographics
NPI:1154627362
Name:THOMPSON, AMAIYA MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMAIYA
Middle Name:MELISSA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMAIYA
Other - Middle Name:MELISSA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1820 W ORANGEWOOD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5052
Mailing Address - Country:US
Mailing Address - Phone:703-310-9495
Mailing Address - Fax:
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5052
Practice Address - Country:US
Practice Address - Phone:703-310-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58134363AM0700X
VA0110003395363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical