Healthcare Provider Details

I. General information

NPI: 1396384665
Provider Name (Legal Business Name): ANN MEEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 VENTURA BLVD STE 315
ENCINO CA
91436-1723
US

IV. Provider business mailing address

1207 SUNSET AVE
SANTA MONICA CA
90405-5840
US

V. Phone/Fax

Practice location:
  • Phone: 818-385-0273
  • Fax:
Mailing address:
  • Phone: 310-422-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: