Provider Demographics
NPI:1063588507
Name:DUAG, MELISSA DE GUZMAN (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DE GUZMAN
Last Name:DUAG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:TABANERA
Other - Last Name:DE GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9436 E. SLAUSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4748
Mailing Address - Country:US
Mailing Address - Phone:562-949-6069
Mailing Address - Fax:562-949-0199
Practice Address - Street 1:9436 E. SLAUSON AVENUE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-949-6069
Practice Address - Fax:562-949-0199
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant