Provider Demographics
NPI:1902191299
Name:MELKUMYAN, VLADIMIR
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:MELKUMYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LAS LOMAS DR APT J204
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2268
Mailing Address - Country:US
Mailing Address - Phone:714-879-8644
Mailing Address - Fax:
Practice Address - Street 1:900 LAS LOMAS DR APT J204
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2268
Practice Address - Country:US
Practice Address - Phone:714-879-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health