Provider Demographics
NPI:1144522384
Name:ILAGAN-ADAMSON, MELLANY JAVIER (PT)
Entity type:Individual
Prefix:MRS
First Name:MELLANY
Middle Name:JAVIER
Last Name:ILAGAN-ADAMSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-0467
Mailing Address - Country:US
Mailing Address - Phone:989-884-3278
Mailing Address - Fax:
Practice Address - Street 1:21183 SAILORS BAY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6920
Practice Address - Country:US
Practice Address - Phone:989-884-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37238261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy