Individual provider Active NPI

Melissa Kathleen Cancio Manuel, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Concord, CA
National Provider Identifier
1861738023
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1861738023 Issued in CA
Practice address
2449 Pacheco St
Concord, CA 94520-2019
Phone
(916) 907-2261
NPI assigned
Dec 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95118610 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1861738023 CA Primary

Addresses

Primary practice location

2449 Pacheco St
Concord, CA 94520-2019

Mailing address

5288 Collect LN
Fairfield, CA 94534-4273
Phone (707) 803-2930

Other names 1

  • Melissa Kathleen Cancio Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250702004463 CA Practitioner - Nurse Practitioner 4880107689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1261 Travis Blvd
Fairfield, CA 94533-4800
Phone (844) 867-8444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95118610CAMDRegistered Nurse
1861738023CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Health Solutions a Professional Medical Corporation CurrentSince Jun 2, 2025 Accepting new patients

Locations

1020 Suncast Ln
Ste 108
El Dorado Hills, CA 95762
Phone (916) 932-0380

1261 Travis Blvd
Ste 190
Fairfield, CA 94533
Phone (707) 427-5020

3300 Webster St
Ste 803
Oakland, CA 94609

360 Post St
Ste 500
San Francisco, CA 94108
Phone (415) 671-6819

360 Post St
Ste 1000
San Francisco, CA 94108
Phone (415) 964-5137

361 3rd St
Ste A
San Rafael, CA 94901
Phone (415) 612-1908

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1861738023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5288 COLLECT LN",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945344273",
            "telephone_number": "707-803-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 PACHECO ST",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202019",
            "telephone_number": "916-907-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANUEL",
        "first_name": "MELISSA",
        "middle_name": "KATHLEEN CANCIO",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-17",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95118610",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "1861738023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "CANCIO",
            "middle_name": "KATHLEEN",
            "credential": "REGISTERED NURSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.