Organization
GUIAMELON MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RITA PARAISO GUIAMELON M.D. (PRESIDENT AND MEDICAL DIRECTOR)
(818) 426-0649
Entity
Organization
Contact information
Practice address
7301 SEPULVEDA BLVD, SUITE 3, VAN NUYS, CA 91405-1782
(818) 786-7710
(818) 786-7711
Mailing address
6130 BONNER AVE, NORTH HOLLYWOOD, CA 91606-4918
(818) 980-6749
(818) 980-6749
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A84265
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A842650
MEDI-CAL PROVIDER NUMBER
CA
01
—
025209 MD00040515
MEDICAL LICENSE
WA
01
—
232930
MEDICAL LICENSE
NY
01
—
A84265
MEDICAL LICENSE
CA
Enumeration date
01/02/2007
Last updated
09/04/2007
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