Provider Demographics
NPI:1073539524
Name:MELVIN L. SELZER, MD, INC
Entity Type:Organization
Organization Name:MELVIN L. SELZER, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-459-1035
Mailing Address - Street 1:6967 PASEO LAREDO
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6425
Mailing Address - Country:US
Mailing Address - Phone:858-459-1035
Mailing Address - Fax:858-459-1021
Practice Address - Street 1:6967 PASEO LAREDO
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6425
Practice Address - Country:US
Practice Address - Phone:858-459-1035
Practice Address - Fax:858-459-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC185422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC1854210Medicaid
CAOOC1854210Medicaid