MEDICARE: MRS. ROMONA DOLAN PA-C

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
1	363A00000X	Physician Assistant	PA13995	CA

General Provider Information

NPI Number	:	1831181932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROMONA DOLAN PA-C

Provider Business Mailing Address
First Line	:	3838 SAN DIMAS ST
Second Line	:	B-111
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-2284
Country	:	US
Telephone Number	:	661-616-1030
Fax Number	:	661-716-5484

Provider Business Practice Location Address
First Line	:	3838 SAN DIMAS ST
Second Line	:	B-111
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-2284
Country	:	US
Telephone Number	:	661-616-1030
Fax Number	:	661-616-1050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/11/2017

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