Healthcare Provider Details

I. General information

NPI: 1740579341
Provider Name (Legal Business Name): MELINA JAIME R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10602 CHAPMAN AVE STE 200
GARDEN GROVE CA
92840-3147
US

IV. Provider business mailing address

327 W WILSON ST SPC 34A
COSTA MESA CA
92627-1600
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-0700
  • Fax: 714-638-5991
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number24692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: