MEDICARE: DONNA SIDNEY MELINKOFF MA, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 25041	CA

General Provider Information

NPI Number	:	1912985862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA SIDNEY MELINKOFF MA, MFT

Provider Business Mailing Address
First Line	:	2211 S HACIENDA BLVD
Second Line	:	SUITE 103-C
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4600
Country	:	US
Telephone Number	:	626-330-7990
Fax Number	:	626-855-5476

Provider Business Practice Location Address
First Line	:	2211 S HACIENDA BLVD
Second Line	:	SUITE 103-C
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4600
Country	:	US
Telephone Number	:	626-330-7990
Fax Number	:	626-855-5476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2006
Last Update Date	:	07/08/2007

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