Provider Demographics
NPI:1659244077
Name:AVILA, MELISSA ANNE DALUZ (BSN, RN, PHN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE DALUZ
Last Name:AVILA
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3125
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-3125
Mailing Address - Country:US
Mailing Address - Phone:530-356-1985
Mailing Address - Fax:530-623-4489
Practice Address - Street 1:201 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-2861
Practice Address - Fax:530-623-4489
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766545163W00000X, 163WS0200X
CA573057163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health