Provider Demographics
NPI:1558161844
Name:PENDERGEST, MELISSA ELISE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELISE
Last Name:PENDERGEST
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELISE
Other - Last Name:TOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4821 KING CIR APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4340
Mailing Address - Country:US
Mailing Address - Phone:714-356-4419
Mailing Address - Fax:
Practice Address - Street 1:301 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7131
Practice Address - Country:US
Practice Address - Phone:714-356-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse