Provider Demographics
NPI:1356672323
Name:MELISSA HURD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MELISSA HURD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-758-1988
Mailing Address - Street 1:161 THUNDER DR
Mailing Address - Street 2:STE. 103
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6016
Mailing Address - Country:US
Mailing Address - Phone:760-758-1988
Mailing Address - Fax:760-758-0922
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:STE. 103
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-758-1988
Practice Address - Fax:760-758-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11117Medicare PIN
CAG83747Medicare UPIN