Provider Demographics
NPI:1659414563
Name:PERRIZO, MELIA TIARE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MELIA
Middle Name:TIARE
Last Name:PERRIZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 DOROTHY ST APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5553
Mailing Address - Country:US
Mailing Address - Phone:310-820-3805
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTURY PARK E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-1705
Practice Address - Country:US
Practice Address - Phone:310-286-0447
Practice Address - Fax:310-286-1224
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist