Healthcare Provider Details

I. General information

NPI: 1629564869
Provider Name (Legal Business Name): MEGAN ELIZABETH HOM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 BACON ST
CONCORD CA
94520-2022
US

IV. Provider business mailing address

9 EQUESTRIAN CT
NOVATO CA
94945-2600
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-3933
  • Fax: 925-609-7255
Mailing address:
  • Phone: 415-491-1210
  • Fax: 415-491-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberEL6827
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: