Healthcare Provider Details

I. General information

NPI: 1528210333
Provider Name (Legal Business Name): MELEA DELISE FUTRELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4832 LINCOLN BLVD
MARINA DEL REY CA
90292-6917
US

IV. Provider business mailing address

5641 S SHERBOURNE DR
LOS ANGELES CA
90056-1318
US

V. Phone/Fax

Practice location:
  • Phone: 310-821-7658
  • Fax:
Mailing address:
  • Phone: 310-710-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: