Healthcare Provider Details

I. General information

NPI: 1750487765
Provider Name (Legal Business Name): SUSAN MELVIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SPRING ST SUITE #1
LONG BEACH CA
90806-1625
US

IV. Provider business mailing address

PO BOX 1807
LONG BEACH CA
90801-1807
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0068
  • Fax: 562-933-0078
Mailing address:
  • Phone: 562-933-0068
  • Fax: 562-933-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number20A5075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A5075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: