Provider Demographics
NPI:1174766398
Name:ROLAND, MELINDA FAITH (MA PT LAC OMD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:FAITH
Last Name:ROLAND
Suffix:
Gender:F
Credentials:MA PT LAC OMD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-7626
Mailing Address - Country:US
Mailing Address - Phone:858-259-1553
Mailing Address - Fax:
Practice Address - Street 1:112 DAHLIA DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2209
Practice Address - Country:US
Practice Address - Phone:858-259-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03037171100000X
MT85171100000X
CATD 8499225100000X
MT686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist