Healthcare Provider Details

I. General information

NPI: 1780131029
Provider Name (Legal Business Name): SCOTT MELGREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S TUSTIN ST
ORANGE CA
92866-2550
US

IV. Provider business mailing address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

V. Phone/Fax

Practice location:
  • Phone: 949-690-9876
  • Fax:
Mailing address:
  • Phone: 714-871-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: