=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346542362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOLNAK, D.O. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2010
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1908 SWEETWATER RD
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-327-0146
-----------------------------------------------------
Fax | 619-327-0150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 SWEETWATER RD
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-327-0146
-----------------------------------------------------
Fax | 619-327-0150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DOUGLAS R DOLNAK
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 619-327-0146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 20A6059
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------