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Organization
GM SALLY MELLGREN, M.D. INC.
Active
Organization
GM SALLY MELLGREN, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOANNE R ROPER (PRACTICE ADMINISTRATOR)
(760) 757-1144
Entity
Organization
Contact information
Practice address
3621 VISTA WAY, OCEANSIDE, CA 92056-4522
(760) 757-1144
(760) 721-7701
Mailing address
3621 VISTA WAY, OCEANSIDE, CA 92056-4522
(760) 757-1144
(760) 721-7701
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G53485
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G534850
—
CA
01
—
33-0241763A
HEALTHNET
CA
01
—
ZZZ07175Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
05/31/2005
Last updated
04/25/2012
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