Provider Demographics
NPI:1013249275
Name:BROWN, MELISSA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15840 VENTURA BLVD 101
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4737
Mailing Address - Country:US
Mailing Address - Phone:818-789-3811
Mailing Address - Fax:818-906-4169
Practice Address - Street 1:15503 VENTURA BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3140
Practice Address - Country:US
Practice Address - Phone:818-789-3811
Practice Address - Fax:818-501-4554
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HK210ZMedicare PIN