Healthcare Provider Details

I. General information

NPI: 1437048949
Provider Name (Legal Business Name): MELISSA RITA SUTOYO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W DUARTE RD STE 208
ARCADIA CA
91007-7675
US

IV. Provider business mailing address

624 W DUARTE RD STE 208
ARCADIA CA
91007-7675
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-9978
  • Fax:
Mailing address:
  • Phone: 626-294-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95035639
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95035639
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95035639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: