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General NPI Number Information
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NPI Number | 1528772019
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Entity Type | Individual
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Provider Name | MARIAH MELLINGER NP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 7944 BIRMINGHAM DR STE 76
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City | SAN DIEGO
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State | CA
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Zip | 92123-2705
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Country | US
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Telephone | 858-939-6764
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Fax |
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Provider Business Mailing Address
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Address Line | 13334 RED CLOUD LN
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City | POWAY
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State | CA
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Zip | 92064-5155
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Country | US
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Telephone | 858-382-4955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 18414
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License Number State | CA
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