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NPI Code Detail

MEDICARE: JESSICA DOLAN R.D.

MEDICARE: JESSICA DOLAN R.D.
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
1133V00000XRegistered DietitianRD1000469CA

General Provider Information

NPI Number : 1710292354
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DOLAN R.D.
Provider Business Mailing Address
First Line : FILE # 54433
Second Line :
City : LOS ANGELES
State : CA
Zip : 90074-4433
Country : US
Telephone Number : 858-784-5888
Fax Number :
Provider Business Practice Location Address
First Line : 9894 GENESEE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92037-1296
Country : US
Telephone Number : 858-626-5066
Fax Number : 858-784-5960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2010
Last Update Date : 08/06/2010

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