Provider Demographics
NPI:1003042417
Name:HERBERT, MEL EAMON (MD)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:EAMON
Last Name:HERBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:818-207-4614
Mailing Address - Fax:
Practice Address - Street 1:5367 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-207-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine