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General NPI Number Information
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NPI Number | 1144522384
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Entity Type | Individual
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Provider Name | MELLANY JAVIER ILAGAN-ADAMSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 21183 SAILORS BAY LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-6920
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Country | US
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Telephone | 989-884-3278
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-0467
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Country | US
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Telephone | 989-884-3278
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Fax |
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT37238
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License Number State | CA
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