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NPI Code Detail

MEDICARE: MR. VLADISLAV MELNICHENKO NP

MEDICARE:  MR. VLADISLAV  MELNICHENKO  NP
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
1363LA2200XAdult Health Nurse PractitionerNP21140CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HE356AOTHERCANORTHERN MCAR PIN

General Provider Information

NPI Number : 1528348273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VLADISLAV MELNICHENKO NP
Provider Business Mailing Address
First Line : 625 S FAIR OAKS AVE STE 245
Second Line :
City : PASADENA
State : CA
Zip : 91105-2665
Country : US
Telephone Number : 626-229-9865
Fax Number : 626-229-9867
Provider Business Practice Location Address
First Line : 1711 W KATELLA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92804-6450
Country : US
Telephone Number : 714-400-2959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 02/18/2025

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