Individual
DR. GRACE M SALLY MELLGREN
Active
Individual
DR. GRACE M SALLY MELLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
G53485
CA
207W00000X
Ophthalmology Physician
Primary
MD2015-0927
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G53480
—
CA
01
—
ZZZ07175Z
BLUE SHIELD OF CA
CA
Enumeration date
10/26/2006
Last updated
04/10/2024
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