Provider Demographics
NPI:1477655306
Name:MELLINGER, SABINE VON BUSSE (MD)
Entity type:Individual
Prefix:DR
First Name:SABINE
Middle Name:VON BUSSE
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABINE
Other - Middle Name:URSULA HEDWIG
Other - Last Name:VON BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3701 WILSHIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2814
Mailing Address - Country:US
Mailing Address - Phone:323-361-3550
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92648207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A926480Medicaid
CA00A926480Medicaid
CAWA92648AMedicare ID - Type Unspecified