Healthcare Provider Details

I. General information

NPI: 1144547183
Provider Name (Legal Business Name): MELANIE MALONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW STE 280
LA JOLLA CA
92037-1417
US

IV. Provider business mailing address

4150 REGENTS PARK ROW STE 280
LA JOLLA CA
92037-1417
US

V. Phone/Fax

Practice location:
  • Phone: 858-225-8873
  • Fax:
Mailing address:
  • Phone: 858-225-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA156432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: