Provider Demographics
NPI:1831582873
Name:MELINA B. JAMPOLIS MD A PROFFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MELINA B. JAMPOLIS MD A PROFFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMPOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-985-2559
Mailing Address - Street 1:4540 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4135
Mailing Address - Country:US
Mailing Address - Phone:818-392-8644
Mailing Address - Fax:
Practice Address - Street 1:12526 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3409
Practice Address - Country:US
Practice Address - Phone:818-985-2559
Practice Address - Fax:818-985-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty