Healthcare Provider Details

I. General information

NPI: 1851736615
Provider Name (Legal Business Name): MELAMED SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 WILSHIRE BLVD STE 808
BEVERLY HILLS CA
90212-1908
US

IV. Provider business mailing address

PO BOX 491518
LOS ANGELES CA
90049-9518
US

V. Phone/Fax

Practice location:
  • Phone: 310-595-5040
  • Fax: 310-593-4360
Mailing address:
  • Phone: 310-595-5040
  • Fax: 310-574-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. HOOMAN MEIR MELAMED
Title or Position: PRESIDENT
Credential: MD
Phone: 310-595-5040