MEDICARE: CALIFORNIA SPECIALTY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician
2	208D00000X	General Practice Physician	A87782	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386684124	OTHER	CA	NPI

General Provider Information

NPI Number	:	1396991766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA SPECIALTY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	213 N ORANGE ST
Second Line	:	SUITE E
City	:	GLENDALE
State	:	CA
Zip	:	91203-2648
Country	:	US
Telephone Number	:	818-660-2647
Fax Number	:	323-297-5220

Provider Business Practice Location Address
First Line	:	213 N ORANGE ST
Second Line	:	SUITE E
City	:	GLENDALE
State	:	CA
Zip	:	91203-2648
Country	:	US
Telephone Number	:	818-660-2647
Fax Number	:	323-297-5220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANAIDA MELKUMIAN
Credential	:	MD
Telephone Number	:	818-660-2647

Provider Enumeration Date	:	08/17/2008
Last Update Date	:	07/01/2011

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