MEDICARE: MELISSA PRZEKLASA AUTH MD PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	A94129	CA

General Provider Information

NPI Number	:	1316387830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA PRZEKLASA AUTH MD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	30131 TOWN CENTER DR STE 195
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2040
Country	:	US
Telephone Number	:	949-495-6100
Fax Number	:	949-354-0612

Provider Business Practice Location Address
First Line	:	30131 TOWN CENTER DR STE 195
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2040
Country	:	US
Telephone Number	:	949-495-6100
Fax Number	:	949-354-0612

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MELISSA PRZEKLASA AUTH
Credential	:	MD
Telephone Number	:	949-495-6100

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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