Provider Demographics
NPI:1902185911
Name:GONZALEZ, MELINDA DRURY (NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DRURY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:DRURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 W CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3010
Mailing Address - Country:US
Mailing Address - Phone:626-397-3521
Mailing Address - Fax:626-397-2930
Practice Address - Street 1:711 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3103
Practice Address - Country:US
Practice Address - Phone:626-397-3521
Practice Address - Fax:626-397-2930
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily