Healthcare Provider Details

I. General information

NPI: 1114316155
Provider Name (Legal Business Name): MS. MELISSA DOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49620 BELUGA RD MARINE MAMMAL CLINIC
SAN DIEGO CA
92152-6506
US

IV. Provider business mailing address

53560 HULL ST CODE 71501
SAN DIEGO CA
92152-5001
US

V. Phone/Fax

Practice location:
  • Phone: 619-553-5273
  • Fax: 619-553-2678
Mailing address:
  • Phone: 619-553-5273
  • Fax: 619-553-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number14246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: