Provider Demographics
NPI:1679368732
Name:FORTANEL, MELISSA JOHANNA (LVN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOHANNA
Last Name:FORTANEL
Suffix:
Gender:
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 E 2ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-3220
Mailing Address - Country:US
Mailing Address - Phone:760-235-6383
Mailing Address - Fax:
Practice Address - Street 1:420 HEFFERNAN AVE STE D
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4718
Practice Address - Country:US
Practice Address - Phone:760-270-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker