Provider Demographics
NPI:1740304773
Name:MAUGHN, MELIDA A (MA)
Entity type:Individual
Prefix:MRS
First Name:MELIDA
Middle Name:A
Last Name:MAUGHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MANZANA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-4029
Mailing Address - Country:US
Mailing Address - Phone:619-475-9062
Mailing Address - Fax:
Practice Address - Street 1:1124 BAY BLVD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7155
Practice Address - Country:US
Practice Address - Phone:619-429-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator