Provider Demographics
NPI:1366025850
Name:REID, MELINDA DIANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:DIANE
Last Name:REID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:3208 EL SUYO DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3030
Mailing Address - Country:US
Mailing Address - Phone:510-299-0811
Mailing Address - Fax:
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily