Provider Demographics
NPI:1437475498
Name:BRIZZIE, MELISSA A (LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BRIZZIE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 RIDGECREST PLACE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-2415
Mailing Address - Country:US
Mailing Address - Phone:619-955-3272
Mailing Address - Fax:
Practice Address - Street 1:3144 EL CAMINO REAL
Practice Address - Street 2:SUITE 204
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2194
Practice Address - Country:US
Practice Address - Phone:760-757-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13338171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist