Provider Demographics
NPI:1487643698
Name:HURD, MELISSA E (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:HURD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11117Medicare ID - Type Unspecified
CAG83747Medicare UPIN