Healthcare Provider Details

I. General information

NPI: 1083911523
Provider Name (Legal Business Name): MELROSE FAMILY CARE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 MELROSE AVE
LOS ANGELES CA
90038-3144
US

IV. Provider business mailing address

5235 MELROSE AVE
LOS ANGELES CA
90038-3144
US

V. Phone/Fax

Practice location:
  • Phone: 323-466-0263
  • Fax: 323-466-1034
Mailing address:
  • Phone: 323-466-0263
  • Fax: 323-466-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA40488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA40488
License Number StateCA

VIII. Authorized Official

Name: ARTIS WOODWARD
Title or Position: CEO
Credential: MD
Phone: 323-466-0263