Healthcare Provider Details

I. General information

NPI: 1124662234
Provider Name (Legal Business Name): SATENIK MELKONYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY STE 250A
LA MESA CA
91942-3134
US

IV. Provider business mailing address

8881 FLETCHER PKWY STE 250A
LA MESA CA
91942-3134
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-2626
  • Fax: 619-286-5412
Mailing address:
  • Phone: 619-229-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPA59363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: