Provider Demographics
NPI:1447336748
Name:ZERMENO, MELANIE ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ROSE
Last Name:ZERMENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:ROSE
Other - Last Name:ZERMENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2601 W. ALAMEDA AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-569-0237
Mailing Address - Fax:818-845-5337
Practice Address - Street 1:2601 W. ALAMEDA AVE.
Practice Address - Street 2:SUITE 414
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-569-0237
Practice Address - Fax:818-845-5337
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA890322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A890320Medicaid
CAI74481Medicare UPIN
CAWA89032AMedicare PIN