Provider Demographics
NPI:1225495294
Name:HUYNH, MELVYN GRACE (DNP, FNP-BC, AGPCNP-)
Entity Type:Individual
Prefix:DR
First Name:MELVYN GRACE
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DNP, FNP-BC, AGPCNP-
Other - Prefix:
Other - First Name:MELVYN GRACE
Other - Middle Name:
Other - Last Name:RABANAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10140 CAMPUS POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1520
Mailing Address - Country:US
Mailing Address - Phone:619-686-3935
Mailing Address - Fax:619-686-3440
Practice Address - Street 1:4077 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2105
Practice Address - Country:US
Practice Address - Phone:619-686-3935
Practice Address - Fax:619-686-3440
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002765363LA2200X, 363LG0600X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology