Basic Information
| Provider Information | |||||||||
| NPI: | 1821382227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAONA | ||||||||
| FirstName: | JESSELYN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MELCHER-POST | ||||||||
| OtherFirstName: | JESSELYN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1300 N 12TH ST STE 605 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028394567 | ||||||||
| FaxNumber: | 6028392067 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N 12TH ST STE 605 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028394567 | ||||||||
| FaxNumber: | 6028392067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2011 | ||||||||
| LastUpdateDate: | 06/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R72650 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.