Healthcare Provider Details

I. General information

NPI: 1275366544
Provider Name (Legal Business Name): MEAGAN RESENDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SANTA ANA AVE UNIT B
COSTA MESA CA
92627-7328
US

IV. Provider business mailing address

1630 SANTA ANA AVE UNIT B
COSTA MESA CA
92627-7328
US

V. Phone/Fax

Practice location:
  • Phone: 774-929-5554
  • Fax:
Mailing address:
  • Phone: 774-929-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95093150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: