Healthcare Provider Details

I. General information

NPI: 1154922185
Provider Name (Legal Business Name): MELISSA LOUISE ZANKICH-PATALAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 CALLE DE LA PLATA STE 230
LAGUNA HILLS CA
92653-7623
US

IV. Provider business mailing address

135 S STATE COLLEGE BLVD STE 350
BREA CA
92821-5814
US

V. Phone/Fax

Practice location:
  • Phone: 805-719-3700
  • Fax: 805-413-9099
Mailing address:
  • Phone: 805-719-3700
  • Fax: 805-413-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: