Healthcare Provider Details

I. General information

NPI: 1326349341
Provider Name (Legal Business Name): TRACIE K. MEITZLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 PLACENTIA AVE STE. #205
NEWPORT BEACH CA
92663
US

IV. Provider business mailing address

307 PLACENTIA AVE STE. #205
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7546
  • Fax: 949-646-7556
Mailing address:
  • Phone: 949-646-7546
  • Fax: 949-646-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: