Provider Demographics
NPI:1053199745
Name:PAYTON, MELISSA GWENDALIN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GWENDALIN
Last Name:PAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 MISSION GORGE RD APT 221
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1576
Mailing Address - Country:US
Mailing Address - Phone:619-772-5597
Mailing Address - Fax:
Practice Address - Street 1:7785 MISSION GORGE RD APT 221
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1576
Practice Address - Country:US
Practice Address - Phone:619-772-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst