Healthcare Provider Details

I. General information

NPI: 1720764582
Provider Name (Legal Business Name): MELANIE VAISBERG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 152
LA MESA CA
91942-3075
US

IV. Provider business mailing address

PO BOX 843270
LOS ANGELES CA
90084-3270
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: