Healthcare Provider Details

I. General information

NPI: 1730525478
Provider Name (Legal Business Name): MELISSA ANGELICA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 OVERLAND AVE
LOS ANGELES CA
90034-6311
US

IV. Provider business mailing address

3745 OVERLAND AVE
LOS ANGELES CA
90034-6311
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-5855
  • Fax:
Mailing address:
  • Phone: 310-392-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN260916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: