Provider Demographics
NPI:1003008103
Name:H MILANO MELLON MD INC
Entity Type:Organization
Organization Name:H MILANO MELLON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:MILANO
Authorized Official - Last Name:MELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-673-3133
Mailing Address - Street 1:915 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4007
Mailing Address - Country:US
Mailing Address - Phone:310-673-3133
Mailing Address - Fax:310-673-4277
Practice Address - Street 1:915 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4007
Practice Address - Country:US
Practice Address - Phone:310-673-3133
Practice Address - Fax:310-673-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30748207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00307480Medicaid
CAA00307480Medicaid
CAA30748Medicare PIN