Healthcare Provider Details

I. General information

NPI: 1164154944
Provider Name (Legal Business Name): ALEXIS NICOLE MEEHAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16756 CHINO CORONA RD
EASTVALE CA
92880-9508
US

IV. Provider business mailing address

1058 TEMECULA CT
SAN DIMAS CA
91773-1466
US

V. Phone/Fax

Practice location:
  • Phone: 909-597-1771
  • Fax:
Mailing address:
  • Phone: 626-253-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: