Provider Demographics
NPI:1639279227
Name:MELGOZA, ARTHUR ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:ALAN
Last Name:MELGOZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29738 RANCHO CALIFORNIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5322
Mailing Address - Country:US
Mailing Address - Phone:951-303-6440
Mailing Address - Fax:951-303-6449
Practice Address - Street 1:29738 RANCHO CALIFORNIA RD STE B
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5322
Practice Address - Country:US
Practice Address - Phone:951-303-6440
Practice Address - Fax:951-303-6449
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16967363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM1113214OtherDEA NUMBER