Provider Demographics
NPI:1689288136
Name:FITZGIBBON, MELISSA EILEEN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:EILEEN
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 CALLE ULTIMO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5633
Mailing Address - Country:US
Mailing Address - Phone:760-994-3820
Mailing Address - Fax:
Practice Address - Street 1:9550 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2799
Practice Address - Country:US
Practice Address - Phone:858-484-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13005003-48102255A2300X
PARTO0005532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer