Healthcare Provider Details

I. General information

NPI: 1376031443
Provider Name (Legal Business Name): MELODY SIMANIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

PO BOX 691217
WEST HOLLYWOOD CA
90069-9217
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8317
  • Fax: 310-315-6143
Mailing address:
  • Phone: 310-498-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: