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General NPI Number Information
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NPI Number | 1477758159
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Entity Type | Organization
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Legal Business Name | TANYA KORMEILI, MD, PC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 2811 WILSHIRE BLVD SUITE 640
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 310-526-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 WILSHIRE BLVD SUITE 640
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 310-526-8301
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TANYA KORMEILI
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Credential | M.D
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Telephone | 310-526-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A83828
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License Number State | CA
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