Basic Information
Provider Information
NPI: 1003142316
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIOGAS
FirstName: MELISSA
MiddleName: ASHLEY
NamePrefix:  
NameSuffix:  
Credential: APRN-FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2815 STEELE CANYON RD
Address2:  
City: EL CAJON
State: CA
PostalCode: 920194619
CountryCode: US
TelephoneNumber: 6195901879
FaxNumber:  
Practice Location
Address1: 2815 STEELE CANYON RD
Address2:  
City: EL CAJON
State: CA
PostalCode: 920194619
CountryCode: US
TelephoneNumber: 6195901879
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/20/2009
LastUpdateDate: 07/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate: 05/26/2020
NPIReactivationDate: 06/09/2020
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X11007229FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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