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Monte Tim Mellon

Emergency Medicine

Allopathic & Osteopathic Physicians

9888 Genesee Ave, La Jolla, CA 92037-1205

PECOS Enrollment

This provider is enrolled in PECOS as MONTE MELLON.

Based on the most recent information from CMS, provider Monte Tim Mellon is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1033229927
Provider Type
Individual
Full Name
Mellon, Monte Tim
Title
Dr.
Credential
M.D. M.B.A.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/30/2006
Last Updated
6/27/2008

Contact Information

Practice Location

9888 Genesee Ave, La Jolla, CA 92037-1205

(858) 626-6150

(858) 626-7117

Mailing Location

PO Box 661687, Arcadia, CA 91066-1687

(626) 447-0296

(626) 447-6057

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License G46909 California

Provider Identifiers

ID	Description	Issuer
ID 00G469090	Description Medicaid	Issuer Unlisted California

Monte Tim Mellon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Spiegler, Frederick Hollister

Tresenriter, Megan

Young, Michael C

Chin, Brian Wai Wen

Huynh, Hung H.

Oyama, Leslie C

Neuendorf, Johannes M.

Clark, Richard F

Hwang, James Quan-Yu

Morikado, Lisa Marie