Provider Demographics
NPI:1023619442
Name:MEEHAN, DOLORES JOSEPHINE (NP)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:JOSEPHINE
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SURREY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2933
Mailing Address - Country:US
Mailing Address - Phone:415-860-7899
Mailing Address - Fax:
Practice Address - Street 1:SOUTH BAY VASCULAR CENTER
Practice Address - Street 2:2255 SOUTH BASCOM AVENUE SUITE 200
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7800
Practice Address - Country:US
Practice Address - Phone:408-376-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015805363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care