Provider Demographics
NPI:1487957874
Name:LOOYZADEH, MELINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MELINA
Middle Name:
Last Name:LOOYZADEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3842
Mailing Address - Country:US
Mailing Address - Phone:818-426-6694
Mailing Address - Fax:
Practice Address - Street 1:1148 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3842
Practice Address - Country:US
Practice Address - Phone:818-426-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist