Provider Demographics
NPI:1144322850
Name:FARRELL, MELANIE A (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-558-8150
Practice Address - Fax:858-346-1024
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG61110207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD880ZOtherSO. CALIFORNIA PTAN
CACA127954OtherNO. CALIFORNIA PTAN
CA00G611100Medicaid
CA00G611100OtherBLUE SHIELD
CA00G611100Medicaid