MEDICARE: MELISSA COLBOURNE

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	104100000X	Social Worker		CA

General Provider Information

NPI Number	:	1821953126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA COLBOURNE

Provider Business Mailing Address
First Line	:	6041 BRISTOL PKWY STE 100
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6601
Country	:	US
Telephone Number	:	310-689-4215
Fax Number	:

Provider Business Practice Location Address
First Line	:	1742 W 84TH PL APT 311
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1875
Country	:	US
Telephone Number	:	310-991-7041
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ MELISSA COLBOURNE ” Practice Location

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