Healthcare Provider Details

I. General information

NPI: 1316316862
Provider Name (Legal Business Name): MELA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 KEYSTONE AVE APT 8
CULVER CITY CA
90232-3331
US

IV. Provider business mailing address

5723 WHITTIER BLVD
LOS ANGELES CA
90022-4222
US

V. Phone/Fax

Practice location:
  • Phone: 323-338-9801
  • Fax:
Mailing address:
  • Phone: 323-721-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number190713AN
License Number StateCA

VIII. Authorized Official

Name: JUAN JOSE MEZA
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 323-728-0100