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General NPI Number Information
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NPI Number | 1285637637
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Entity Type | Organization
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Legal Business Name | GM SALLY MELLGREN, M.D. INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 3621 VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-4522
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Country | US
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Telephone | 760-757-1144
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Fax | 760-721-7701
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Provider Business Mailing Address
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Address Line | 3621 VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-4522
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Country | US
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Telephone | 760-757-1144
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Fax | 760-721-7701
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. JOANNE R ROPER
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Credential |
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Telephone | 760-757-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G53485
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License Number State | CA
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