Healthcare Provider Details

I. General information

NPI: 1114084092
Provider Name (Legal Business Name): GUIAMELON MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 SEPULVEDA BLVD SUITE 3
VAN NUYS CA
91405-1782
US

IV. Provider business mailing address

6130 BONNER AVE
NORTH HOLLYWOOD CA
91606-4918
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-7710
  • Fax: 818-786-7711
Mailing address:
  • Phone: 818-980-6749
  • Fax: 818-980-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84265
License Number StateCA

VIII. Authorized Official

Name: DR. RITA PARAISO GUIAMELON
Title or Position: PRESIDENT AND MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-426-0649