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General NPI Number Information
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NPI Number | 1790812162
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Entity Type | Individual
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Provider Name | MELITA TALENE PETROSSIAN MD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 1301 20TH ST STE 150
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City | SANTA MONICA
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State | CA
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Zip | 90404-2050
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Country | US
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Telephone | 310-582-7433
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Fax | 310-582-7495
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Provider Business Mailing Address
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Address Line | 2200 SANTA MONICA BLVD SUITE 112
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City | SANTA MONICA
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State | CA
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Zip | 90404-2312
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Country | US
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Telephone | 310-582-7433
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Fax | 310-582-7495
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A120954
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License Number State | CA
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