Healthcare Provider Details

I. General information

NPI: 1972306702
Provider Name (Legal Business Name): MICHAEL MEENEN CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14422 CAMINITO LAZANJA
SAN DIEGO CA
92127-3631
US

IV. Provider business mailing address

14422 CAMINITO LAZANJA
SAN DIEGO CA
92127-3631
US

V. Phone/Fax

Practice location:
  • Phone: 858-342-2002
  • Fax:
Mailing address:
  • Phone: 858-342-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: