Healthcare Provider Details

I. General information

NPI: 1720262470
Provider Name (Legal Business Name): MELANIE SANTOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAGUNA RD
FULLERTON CA
92835-3614
US

IV. Provider business mailing address

150 LAGUNA RD
FULLERTON CA
92835-3614
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-4800
  • Fax: 714-447-1098
Mailing address:
  • Phone: 714-447-4800
  • Fax: 714-447-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA93982
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA93892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: