Provider Demographics
NPI:1376634568
Name:GONDEN, MELISSA CARDIASMENOS (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CARDIASMENOS
Last Name:GONDEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:MARIA
Other - Last Name:CARDIASMENOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3357
Mailing Address - Country:US
Mailing Address - Phone:415-833-4798
Mailing Address - Fax:415-833-4201
Practice Address - Street 1:2200 OFARRELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3357
Practice Address - Country:US
Practice Address - Phone:415-833-4798
Practice Address - Fax:415-833-4201
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7919363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23236Medicare UPIN