MEDICARE: ALBERT J MELARAGNO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	G35394	CA

General Provider Information

NPI Number	:	1336146711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT J MELARAGNO M.D.

Provider Business Mailing Address
First Line	:	10515 BALBOA BLVD, SUITE 360
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6346
Country	:	US
Telephone Number	:	818-832-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	10515 BALBOA BLVD, SUITE 360
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6346
Country	:	US
Telephone Number	:	818-832-3322
Fax Number	:	818-360-9171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/05/2012

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