Provider Demographics
NPI:1396980074
Name:MELLANO, CHRISTEN R (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:R
Last Name:MELLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:STE 180
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-257-1500
Mailing Address - Fax:310-257-1508
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:STE 180
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-257-1500
Practice Address - Fax:310-257-1508
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110932207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223231Medicare PIN