Provider Demographics
NPI:1457683112
Name:DEAN, MELISSA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 SANTA INES WAY
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2925
Mailing Address - Country:US
Mailing Address - Phone:408-778-7728
Mailing Address - Fax:
Practice Address - Street 1:1488 SANTA INES WAY
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2925
Practice Address - Country:US
Practice Address - Phone:408-778-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA304176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula