Provider Demographics
NPI:1942593116
Name:JAMPOLIS, MELINA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINA
Middle Name:BETH
Last Name:JAMPOLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 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:818-301-1944
Practice Address - Street 1:12526 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3409
Practice Address - Country:US
Practice Address - Phone:818-392-8644
Practice Address - Fax:818-301-1944
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine