Provider Demographics
NPI:1952559262
Name:VIZON, MELANIE AGUILO (RN NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:AGUILO
Last Name:VIZON
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:TONGSON
Other - Last Name:AGUILO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:1061 TIERRA DEL REY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7880
Practice Address - Country:US
Practice Address - Phone:619-498-5454
Practice Address - Fax:619-498-5455
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17396363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN