Provider Demographics
NPI:1629774435
Name:ABEYTA, MELANIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:DISHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11959 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2748
Mailing Address - Country:US
Mailing Address - Phone:424-372-9088
Mailing Address - Fax:
Practice Address - Street 1:11959 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2748
Practice Address - Country:US
Practice Address - Phone:424-372-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner