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General NPI Number Information
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NPI Number | 1891590329
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Entity Type | Individual
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Provider Name | JESSE S MELLEMA
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Gender | Male
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 16561 BOLSA CHICA ST STE 100
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3594
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Country | US
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Telephone | 714-364-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 16681 LYNN LN APT A
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3461
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Country | US
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Telephone | 714-334-6685
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 307646
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License Number State | CA
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