Healthcare Provider Details

I. General information

NPI: 1528348273
Provider Name (Legal Business Name): VLADISLAV MELNICHENKO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W KATELLA AVE
ANAHEIM CA
92804-6450
US

IV. Provider business mailing address

625 S FAIR OAKS AVE STE 245
PASADENA CA
91105-2665
US

V. Phone/Fax

Practice location:
  • Phone: 714-400-2959
  • Fax:
Mailing address:
  • Phone: 626-229-9865
  • Fax: 626-229-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP21140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: