Healthcare Provider Details

I. General information

NPI: 1336373117
Provider Name (Legal Business Name): MEAGAN SHEA RHOADES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date: 04/04/2021
Reactivation Date: 05/03/2021

III. Provider practice location address

5332 JACKSON DR
LA MESA CA
91942-3040
US

IV. Provider business mailing address

600 B ST #1570
SAN DIEGO CA
92101
US

V. Phone/Fax

Practice location:
  • Phone: 619-416-2771
  • Fax:
Mailing address:
  • Phone: 619-615-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7228
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRU95244615
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: