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NPI Code Detail

MEDICARE: MRS. SUSAN ELIZABETH MELLEN LVN

MEDICARE: MRS. SUSAN ELIZABETH MELLEN LVN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse231494CA

General Provider Information

NPI Number : 1134375843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN ELIZABETH MELLEN LVN
Provider Business Mailing Address
First Line : 883 N POINSETTIA AVE
Second Line :
City : BREA
State : CA
Zip : 92821-2215
Country : US
Telephone Number : 562-690-7681
Fax Number :
Provider Business Practice Location Address
First Line : 550 N FLOWER ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92703-2361
Country : US
Telephone Number : 714-647-4666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 08/13/2008

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