Provider Demographics
NPI:1699748301
Name:GUIAMELON, RITA PARAISO (MD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:PARAISO
Last Name:GUIAMELON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 BONNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4918
Mailing Address - Country:US
Mailing Address - Phone:818-980-6749
Mailing Address - Fax:818-980-6749
Practice Address - Street 1:7301 SEPULVEDA BLVD
Practice Address - Street 2:SUITE-3
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1782
Practice Address - Country:US
Practice Address - Phone:818-786-7710
Practice Address - Fax:818-786-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84265208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232930OtherMEDICAL LICENSE NUMBER
WAMD00040515OtherMEDICAL LICENSE NUMBER
CAA84265OtherMEDICAL LICENSE NUMBER
CAA84265OtherMEDICAL LICENSE NUMBER