Provider Demographics
NPI:1104086297
Name:AVILA-MELJEM, CARLOS HUMBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:AVILA-MELJEM
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 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-285-0400
Mailing Address - Fax:310-285-0222
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:SUITE # 301
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-285-0400
Practice Address - Fax:310-285-0222
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA797972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery