Provider Demographics
NPI:1215495635
Name:LONDON, MELISSA J (PA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:J
Last Name:LONDON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3132 W MARCH LN STE 5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2354
Practice Address - Country:US
Practice Address - Phone:209-475-5500
Practice Address - Fax:209-475-5535
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2021-09-07
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Provider Licenses
StateLicense IDTaxonomies
CA58288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant