Healthcare Provider Details

I. General information

NPI: 1699748301
Provider Name (Legal Business Name): RITA PARAISO GUIAMELON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: