Basic Information
| Provider Information | |||||||||
| NPI: | 1144322850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9610 GRANITE RIDGE DR | ||||||||
| Address2: | STE B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588108000 | ||||||||
| FaxNumber: | 8582681911 | ||||||||
| Practice Location | |||||||||
| Address1: | 9834 GENESEE AVE | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585588150 | ||||||||
| FaxNumber: | 8583461024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | G61110 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | CD880Z | 01 | CA | SO. CALIFORNIA PTAN | OTHER | CA127954 | 01 | CA | NO. CALIFORNIA PTAN | OTHER | 00G611100 | 05 | CA | MEDICAID | 00G611100 | 01 | CA | BLUE SHIELD | OTHER |