Healthcare Provider Details

I. General information

NPI: 1801702923
Provider Name (Legal Business Name): MEGAN RAE DIVINAGRACIA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE 320
ARCADIA CA
91007-1500
US

IV. Provider business mailing address

11252 VISTA LN
EL MONTE CA
91731-1456
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-3516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95286150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: