Provider Demographics
NPI:1649680265
Name:MUSAKHANYAN, MELLANIE M
Entity type:Individual
Prefix:
First Name:MELLANIE
Middle Name:M
Last Name:MUSAKHANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4063 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2536
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:323-666-1417
Practice Address - Street 1:4063 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2536
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:323-666-1417
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse