MEDICARE: MELINA ANDREI JIMENEZ CELAYA

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	363A00000X	Physician Assistant	PA65101	CA

General Provider Information

NPI Number	:	1568239556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINA ANDREI JIMENEZ CELAYA

Provider Business Mailing Address
First Line	:	1720 S BELLAIRE ST STE 700
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4312
Country	:	US
Telephone Number	:	866-932-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2709
Country	:	US
Telephone Number	:	858-298-6273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	05/26/2026

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