Provider Demographics
NPI:1972265668
Name:MARTELLY, MELISSA (RNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARTELLY
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 VILLAGE COMMONS BLVD UNIT 23
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6825
Mailing Address - Country:US
Mailing Address - Phone:224-622-8230
Mailing Address - Fax:
Practice Address - Street 1:17782 COWAN STE AA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6030
Practice Address - Country:US
Practice Address - Phone:949-722-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health