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General NPI Number Information
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NPI Number | 1174896120
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Entity Type | Organization
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Legal Business Name | MELANIE PALM M.D., P.C.
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 437 S HIGHWAY 101 SUITE 217
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2228
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Country | US
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Telephone | 858-792-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 437 S HIGHWAY 101 SUITE 217
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2228
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Country | US
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Telephone | 858-792-7546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELANIE DAWN PALM
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Credential | M.D.
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Telephone | 773-860-7703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A103899
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License Number State | CA
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