Provider Demographics
NPI:1487613519
Name:HAWKS, MELISSA SARAH (PAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SARAH
Last Name:HAWKS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 TRAVIS BLVD
Mailing Address - Street 2:#150
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4897
Mailing Address - Country:US
Mailing Address - Phone:707-426-5407
Mailing Address - Fax:707-426-6376
Practice Address - Street 1:1261 TRAVIS BLVD
Practice Address - Street 2:#150
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4897
Practice Address - Country:US
Practice Address - Phone:707-426-5407
Practice Address - Fax:707-426-6376
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00202421OtherRAILROAD RETIREMENT BOARD
Q37642Medicare UPIN
CA0PA176000Medicare PIN