MEDICARE: MS. MELISSA DOLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian	14246	CA

General Provider Information

NPI Number	:	1114316155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA DOLAN

Provider Business Mailing Address
First Line	:	53560 HULL ST
Second Line	:	CODE 71501
City	:	SAN DIEGO
State	:	CA
Zip	:	92152-5001
Country	:	US
Telephone Number	:	619-553-5273
Fax Number	:	619-553-2678

Provider Business Practice Location Address
First Line	:	49620 BELUGA RD
Second Line	:	MARINE MAMMAL CLINIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92152-6506
Country	:	US
Telephone Number	:	619-553-5273
Fax Number	:	619-553-2678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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