1922130996 NPI number — MELISSA PROSCH HUY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922130996 NPI number — MELISSA PROSCH HUY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISSA PROSCH HUY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922130996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 E BRYSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-936-0528
Provider Business Mailing Address Fax Number:
714-693-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 ORCHARD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630-8321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-936-0528
Provider Business Practice Location Address Fax Number:
714-693-9333
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUY
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-936-0528

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY 18078 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)