=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427543909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEVERLY HILLS NEUROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 07/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8436 W 3RD ST STE 800
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-850-0183
-----------------------------------------------------
Fax | 818-921-4129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8436 W 3RD ST STE 800
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-850-0183
-----------------------------------------------------
Fax | 818-921-4129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FARHAD MELAMED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-695-1830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------