Healthcare Provider Details

I. General information

NPI: 1568239556
Provider Name (Legal Business Name): MELINA ANDREI JIMENEZ CELAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MEADOW LARK DR
SAN DIEGO CA
92123-2709
US

IV. Provider business mailing address

1720 S BELLAIRE ST STE 700
DENVER CO
80222-4312
US

V. Phone/Fax

Practice location:
  • Phone: 858-298-6273
  • Fax:
Mailing address:
  • Phone: 866-932-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: