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General NPI Number Information
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NPI Number | 1376031443
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Entity Type | Individual
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Provider Name | MELODY SIMANIAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2121 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2303
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Country | US
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Telephone | 310-829-8317
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Fax | 310-315-6143
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Provider Business Mailing Address
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Address Line | PO BOX 691217
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-9217
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Country | US
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Telephone | 310-498-1506
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55643
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License Number State | CA
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