MEDICARE: MELISSA COLEMAN MD

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	208000000X	Pediatrics Physician	A112318	CA

General Provider Information

NPI Number	:	1831485853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA COLEMAN MD

Provider Business Mailing Address
First Line	:	826 S HOBART BLVD APT 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2714
Country	:	US
Telephone Number	:	213-793-6704
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 S HOBART BLVD APT 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2714
Country	:	US
Telephone Number	:	213-793-6704
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	02/11/2022

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