Healthcare Provider Details

I. General information

NPI: 1720789373
Provider Name (Legal Business Name): MEGHAN C FIRTH NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1485 MILLAR DR
GLENDALE CA
91206-2633
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-7066
  • Fax:
Mailing address:
  • Phone: 818-749-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number95024502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: