Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G30081 | CA |
NPI | 1598824104 |
---|---|
Provider Name | Michael H. Mellon |
First Address | San Diego, CA 92120-2507 |
Second Address | San Diego, CA 92120-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 23/09/2008 |