Provider Demographics
NPI:1760742225
Name:PEREZ, MELANIE PAED BALUYUT (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:PAED BALUYUT
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:PAED
Other - Last Name:BALUYUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 VALE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3845
Mailing Address - Country:US
Mailing Address - Phone:510-233-9300
Mailing Address - Fax:510-233-4750
Practice Address - Street 1:2101 VALE RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-233-9300
Practice Address - Fax:510-233-4750
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812650163W00000X
CA95000344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse