Healthcare Provider Details

I. General information

NPI: 1639658107
Provider Name (Legal Business Name): MEGHAN FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6762 LEXINGTON AVE
LOS ANGELES CA
90038-1217
US

IV. Provider business mailing address

6762 LEXINGTON AVE
LOS ANGELES CA
90038-1217
US

V. Phone/Fax

Practice location:
  • Phone: 323-380-7590
  • Fax:
Mailing address:
  • Phone: 323-380-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number288404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: