Provider Demographics
NPI:1518918358
Name:IRWIN, MELANIE C NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:C NICOLE
Last Name:IRWIN
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 1:1010 W. LAVETA AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-2724
Mailing Address - Fax:714-835-2751
Practice Address - Street 1:1010 W. LAVETA AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-835-2724
Practice Address - Fax:714-835-2751
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA998722081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
029906261LOtherHUMANA
WI34567000Medicaid
029906261LOtherHUMANA
0095Q73601Medicare ID - Type Unspecified