Edison Victor De Mello, MD PHD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N78519 Issued in CA

Practice address

520 Arizona Avenue
Santa Monica, CA 90401

Phone

(310) 451-8880

Fax

(310) 451-8803

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 21, 2015 through Jul 21, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053532044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 ARIZONA AVENUE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90401",
            "telephone_number": "310-451-8880",
            "fax_number": "310-451-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 ARIZONA AVENUE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90401",
            "telephone_number": "310-451-8880",
            "fax_number": "310-451-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE MELLO",
        "first_name": "EDISON",
        "middle_name": "VICTOR",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "N78519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sagie De Guzman, PHD, A-CNS, ANP-C
• Amanda Noel De la Cerda, MD
• Angelica De la Fuente, M.S.
• Shantel Kimberly De Leon, LVN
• Theresa De Long, MFT
• Sandra De Silva, M.A., PH.D.
• Stella Nikki De Stefanis, L.AC
• Monya De, MD, MPH
• Teresa Dean, M.D.
• Deanro a Professional Medical Corporation

• Family Medicine Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.