Individual
MELISSA HISAKO REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1261 TRAVIS BLVD STE 100, FAIRFIELD, CA 94533-4804
(707) 422-0543
Mailing address
207 BRIDGEWATER CIR, SUISUN CITY, CA 94585-1774
(707) 389-6421
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
Z9T4J4S3
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9885321
KAISER
CA
Enumeration date
01/18/2020
Last updated
01/18/2020
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