Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT 4199 | CA |
Y | 213ES0000X | Sports Medicine | AT 4199 | CA |
NPI | 1114309341 |
---|---|
Provider Name | Julie Mello |
First Address | Danville, CA 94526-1505 |
Second Address | Danville, CA 94526-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 24/06/2015 |