Healthcare Provider Details

I. General information

NPI: 1053607879
Provider Name (Legal Business Name): MEGHAN M WALLMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W PUEBLO ST
SANTA BARBARA CA
93105
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-8911
  • Fax:
Mailing address:
  • Phone: 805-681-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA162238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: