Provider Demographics
NPI:1932366382
Name:MELLON, TRAVIS JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:MELLON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 VIBORG RD
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2220
Mailing Address - Country:US
Mailing Address - Phone:805-686-3989
Mailing Address - Fax:
Practice Address - Street 1:2050 VIBORG RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2220
Practice Address - Country:US
Practice Address - Phone:805-686-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243979207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine