Provider Demographics
NPI:1255510053
Name:DOLSTEIN, MICHELLE JOY (PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JOY
Last Name:DOLSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 FROST ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2778
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:
Practice Address - Street 1:8010 FROST ST
Practice Address - Street 2:2ND FLR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2778
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACV590YMedicare Oscar/Certification
CACV590ZMedicare UPIN