Provider Demographics
NPI:1104302892
Name:KIDD, MELISSA (CHC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:CHC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1671 CHALCEDONY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3138
Mailing Address - Country:US
Mailing Address - Phone:337-519-8745
Mailing Address - Fax:
Practice Address - Street 1:1671 CHALCEDONY ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3138
Practice Address - Country:US
Practice Address - Phone:337-519-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator