Provider Demographics
NPI:1689790727
Name:BALESTRA, MELANIE (NP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:BALESTRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SANTA COMBA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8898
Mailing Address - Country:US
Mailing Address - Phone:949-733-3573
Mailing Address - Fax:949-451-5845
Practice Address - Street 1:362 THIRD STREET
Practice Address - Street 2:
Practice Address - City:LAUGNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-494-0761
Practice Address - Fax:949-494-3514
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1729860363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics