Healthcare Provider Details

I. General information

NPI: 1144322850
Provider Name (Legal Business Name): MELANIE A. FARRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 312
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR STE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-8150
  • Fax: 858-346-1024
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG61110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: