Provider Demographics
NPI:1801197983
Name:MELISSA FROST RN A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MELISSA FROST RN A PROFESSIONAL CORPORATION
Other - Org Name:FROST MENTAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:626-600-8543
Mailing Address - Street 1:415 W CARROLL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4208
Mailing Address - Country:US
Mailing Address - Phone:626-600-8543
Mailing Address - Fax:626-228-2226
Practice Address - Street 1:415 W CARROLL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-600-8543
Practice Address - Fax:626-228-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANR491644363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANR4916440OtherMEDI-CAL
CAMF1012020OtherDEA
CAQ51393Medicare UPIN