Provider Demographics
NPI:1316387830
Name:MELISSA PRZEKLASA AUTH MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MELISSA PRZEKLASA AUTH MD PROFESSIONAL CORPORATION
Other - Org Name:ORANGE COUNTY CHILD NEUROLOGY ELECTRODIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRZEKLASA AUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-495-6100
Mailing Address - Street 1:30131 TOWN CENTER DR STE 195
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2040
Mailing Address - Country:US
Mailing Address - Phone:949-495-6100
Mailing Address - Fax:949-354-0612
Practice Address - Street 1:30131 TOWN CENTER DR STE 195
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2040
Practice Address - Country:US
Practice Address - Phone:949-495-6100
Practice Address - Fax:949-354-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA941292084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty