Provider Demographics
NPI:1881072239
Name:MONDALA, MELISSA MARCELO
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARCELO
Last Name:MONDALA
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 1:16002 LEGACY RD UNIT 215
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2782
Mailing Address - Country:US
Mailing Address - Phone:909-837-0735
Mailing Address - Fax:
Practice Address - Street 1:1501 WESTCLIFF DR STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5518
Practice Address - Country:US
Practice Address - Phone:949-569-8877
Practice Address - Fax:949-289-2612
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1470842083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine