Provider Demographics
NPI:1457890717
Name:ALKIN, MELIS
Entity Type:Individual
Prefix:
First Name:MELIS
Middle Name:
Last Name:ALKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELIS
Other - Middle Name:
Other - Last Name:GAZIOGLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:829 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3115
Mailing Address - Country:US
Mailing Address - Phone:909-344-6705
Mailing Address - Fax:
Practice Address - Street 1:5122 KATELLA AVE STE 307
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6838
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical