Provider Demographics
NPI:1275584898
Name:MELKUMIAN, ANAIDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANAIDA
Middle Name:
Last Name:MELKUMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 ATLANTIC AVE
Mailing Address - Street 2:STE 223
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1740
Mailing Address - Country:US
Mailing Address - Phone:562-595-6770
Mailing Address - Fax:562-595-5553
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:223
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:562-595-6770
Practice Address - Fax:562-595-6770
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91329207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A913290Medicaid
CAA91329Medicare PIN
CA00A913290Medicaid