Healthcare Provider Details

I. General information

NPI: 1568800431
Provider Name (Legal Business Name): TRISTAN MELE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18523 CORWIN RD STE A
APPLE VALLEY CA
92307-2300
US

IV. Provider business mailing address

PO BOX 741729
ATLANTA GA
30374-1729
US

V. Phone/Fax

Practice location:
  • Phone: 909-712-2764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11732540-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A24049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: