MEDICARE: DR. W. DAVID MELLO M.D.

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
1	207RG0100X	Gastroenterology Physician	G040719	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376549733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. W. DAVID MELLO M.D.

Provider Business Mailing Address
First Line	:	1818 VERDUGO BLVD
Second Line	:	STE 107
City	:	GLENDALE
State	:	CA
Zip	:	91208-1400
Country	:	US
Telephone Number	:	818-790-0122
Fax Number	:	818-790-4623

Provider Business Practice Location Address
First Line	:	1818 VERDUGO BLVD
Second Line	:	STE 107
City	:	GLENDALE
State	:	CA
Zip	:	91208-1400
Country	:	US
Telephone Number	:	818-790-0122
Fax Number	:	818-790-4623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/01/2023

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