Healthcare Provider Details

I. General information

NPI: 1316213705
Provider Name (Legal Business Name): MEGAN THERESE LYNCH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 VALLEY CENTRE DR STE 4D
SAN DIEGO CA
92130-2332
US

IV. Provider business mailing address

3881 VALLEY CENTRE DR STE 4D
SAN DIEGO CA
92130-2332
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3465
  • Fax:
Mailing address:
  • Phone: 858-764-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A13924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: