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General NPI Number Information
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NPI Number | 1063890929
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Entity Type | Individual
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Provider Name | MELISSA A TREVELLINE MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE STE L
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 909-551-0205
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Fax | 909-345-7084
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE STE L
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 909-551-0205
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Fax | 909-345-7084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD465294
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A161980
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License Number State | CA
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