Provider Demographics
NPI:1326162579
Name:MESSOLINE, MATTHEW F (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:F
Last Name:MESSOLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 CARMEL COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2153
Mailing Address - Country:US
Mailing Address - Phone:858-499-2708
Mailing Address - Fax:
Practice Address - Street 1:12710 CARMEL COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2153
Practice Address - Country:US
Practice Address - Phone:858-499-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine