Healthcare Provider Details

I. General information

NPI: 1821952219
Provider Name (Legal Business Name): MAUREEN MACLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HUGHES STE 130
IRVINE CA
92618-2060
US

IV. Provider business mailing address

21851 NEWLAND ST
HUNTINGTON BEACH CA
92646-7607
US

V. Phone/Fax

Practice location:
  • Phone: 443-480-8057
  • Fax:
Mailing address:
  • Phone: 443-480-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: