Healthcare Provider Details

I. General information

NPI: 1902445620
Provider Name (Legal Business Name): IRINA L MELNIK, MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD STE 203
MILL VALLEY CA
94941-3025
US

IV. Provider business mailing address

9 EQUESTRIAN CT
NOVATO CA
94945-2600
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-3808
  • Fax: 415-388-3089
Mailing address:
  • Phone: 415-491-1210
  • Fax: 415-491-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: IRINA L MELNIK
Title or Position: OWNER
Credential: MD
Phone: 415-491-1210