Healthcare Provider Details

I. General information

NPI: 1972528305
Provider Name (Legal Business Name): NICOLAS MELO M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD 8215 NT
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8700 BEVERLY BLVD., 8215 NT CEDARS-SINAI MEDICAL CENTER
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5784
  • Fax:
Mailing address:
  • Phone: 180-023-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA111964
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA111964
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA111964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: