Individual
DR. ENRICO A MELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17500 FOOTHILL BLVD, SUITE A-2, FONTANA, CA 92335-3798
(909) 428-0170
(909) 428-5145
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G59473
CA
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
G59473
CA
2083P0901X
Public Health & General Preventive Medicine Physician
G59473
CA
208VP0000X
Pain Medicine Physician
G59473
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720241961
MEDI-CAL
CA
Enumeration date
10/23/2007
Last updated
07/22/2010
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