Provider Demographics
NPI:1124861893
Name:MCGEORGE, MELISSA K (DACM, LAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:MCGEORGE
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-4402
Mailing Address - Country:US
Mailing Address - Phone:831-262-1951
Mailing Address - Fax:
Practice Address - Street 1:4514 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1427
Practice Address - Country:US
Practice Address - Phone:619-470-4714
Practice Address - Fax:619-470-3452
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA19993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No374J00000XNursing Service Related ProvidersDoula