Provider Demographics
NPI:1780290460
Name:CONBOY, MELISSA S (CMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:CONBOY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:S
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5295 TOSCANA WAY APT 7111
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5335
Mailing Address - Country:US
Mailing Address - Phone:310-849-1904
Mailing Address - Fax:
Practice Address - Street 1:4469 MORRELL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4642
Practice Address - Country:US
Practice Address - Phone:310-849-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist