Healthcare Provider Details

I. General information

NPI: 1831389964
Provider Name (Legal Business Name): MARILYN ANN MEHLMAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 320
PASADENA CA
91105-3023
US

IV. Provider business mailing address

10 CONGRESS ST STE 320
PASADENA CA
91105-3023
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-9474
  • Fax: 626-585-9480
Mailing address:
  • Phone: 626-585-9474
  • Fax: 626-585-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG035270
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG035270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: