Provider Demographics
NPI:1669574802
Name:MELLON, HORACE MILANO (MD)
Entity type:Individual
Prefix:DR
First Name:HORACE
Middle Name:MILANO
Last Name:MELLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H
Other - Middle Name:MILANO
Other - Last Name:MELLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:310-373-4277
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:310-373-4277
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30748208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00307480Medicaid
CAA00307480Medicaid
A26216Medicare UPIN