Provider Demographics
NPI:1114316155
Name:DOLAN, MELISSA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53560 HULL ST
Mailing Address - Street 2:CODE 71501
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92152-5001
Mailing Address - Country:US
Mailing Address - Phone:619-553-5273
Mailing Address - Fax:619-553-2678
Practice Address - Street 1:49620 BELUGA RD
Practice Address - Street 2:MARINE MAMMAL CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92152-6506
Practice Address - Country:US
Practice Address - Phone:619-553-5273
Practice Address - Fax:619-553-2678
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14246174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian