Provider Demographics
NPI:1679898704
Name:MYERS-MALLORY, MELYNDA RAE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:RAE
Last Name:MYERS-MALLORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27450 YNEZ RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4649
Mailing Address - Country:US
Mailing Address - Phone:951-383-4333
Mailing Address - Fax:951-506-2361
Practice Address - Street 1:27450 YNEZ RD
Practice Address - Street 2:100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4671
Practice Address - Country:US
Practice Address - Phone:951-383-4333
Practice Address - Fax:951-506-2361
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF7652363LP2300X
CA7652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care