Basic Information
| Provider Information | |||||||||
| NPI: | 1578754826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOOMAN M MELAMED MD A PROF CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13160 MINDANAO WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108543800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 SHELDON ST | ||||||||
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| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902453915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103224278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | MELAMED | ||||||||
| AuthorizedOfficialFirstName: | HOOMAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3108543800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A85644 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.