Healthcare Provider Details

I. General information

NPI: 1063888782
Provider Name (Legal Business Name): ANA CECILIA MELNYK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 FOOTHILL BLVD
TUJUNGA CA
91042-2717
US

IV. Provider business mailing address

7150 FOOTHILL BLVD
TUJUNGA CA
91042-2717
US

V. Phone/Fax

Practice location:
  • Phone: 818-352-2669
  • Fax: 818-352-4980
Mailing address:
  • Phone: 818-352-2669
  • Fax: 818-352-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: