Healthcare Provider Details

I. General information

NPI: 1912885807
Provider Name (Legal Business Name): DYLAN THOMAS MEEHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 N 61ST AVE APT 2076
GLENDALE AZ
85302-6768
US

IV. Provider business mailing address

8150 N 61ST AVE APT 2076
GLENDALE AZ
85302-6768
US

V. Phone/Fax

Practice location:
  • Phone: 909-213-8957
  • Fax:
Mailing address:
  • Phone: 909-213-8957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number087311
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: