Provider Demographics
NPI:1316998776
Name:MELLOR, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MELLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66657
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0657
Mailing Address - Country:US
Mailing Address - Phone:310-645-1024
Mailing Address - Fax:213-618-3367
Practice Address - Street 1:602 DEEP VALLEY DR STE 314
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3745
Practice Address - Country:US
Practice Address - Phone:310-645-1024
Practice Address - Fax:213-618-3367
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G75400OtherBLUE SHIELD
CAWG75407DMedicare ID - Type Unspecified
F85973Medicare UPIN