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General NPI Number Information
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NPI Number | 1356855142
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Entity Type | Individual
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Provider Name | MELISSA FILLMORE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2001 WILSHIRE BLVD STE 320
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City | SANTA MONICA
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State | CA
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Zip | 90403-5683
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Country | US
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Telephone | 310-566-2006
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Fax | 424-322-1214
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Provider Business Mailing Address
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Address Line | 2001 WILSHIRE BLVD STE 320
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City | SANTA MONICA
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State | CA
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Zip | 90403-5683
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Country | US
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Telephone | 310-566-2006
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Fax | 424-322-1214
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN.428291
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95013755
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License Number State | CA
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