Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A79797 | CA |
NPI | 1104086297 |
---|---|
Provider Name | Dr. Carlos Humberto Avila-Meljem |
First Address | Beverly Hills, CA 90210-4310 |
Second Address | Beverly Hills, CA 90210-4310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 11/06/2008 |