Provider Demographics
NPI:1134417447
Name:JOHANSSON, MELANIE DYAN (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DYAN
Last Name:JOHANSSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 SUNRISE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3153
Mailing Address - Country:US
Mailing Address - Phone:916-352-7777
Mailing Address - Fax:877-354-4771
Practice Address - Street 1:6939 SUNRISE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3153
Practice Address - Country:US
Practice Address - Phone:916-352-7777
Practice Address - Fax:877-354-4771
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC183026208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine