Provider Demographics
NPI:1447545983
Name:GRIFFIN, MELISSA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:GRIFFIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:TALASKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-3851
Mailing Address - Fax:310-423-3522
Practice Address - Street 1:127 S SAN VICENTE BLVD STE A3100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:310-423-3851
Practice Address - Fax:310-423-3522
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
CAPA21653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical