Healthcare Provider Details

I. General information

NPI: 1629799069
Provider Name (Legal Business Name): MEAGAN KATHLEEN WESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 AVALON DR
SOUTH SAN FRANCISCO CA
94080-5558
US

IV. Provider business mailing address

534 AVALON DR
SOUTH SAN FRANCISCO CA
94080-5558
US

V. Phone/Fax

Practice location:
  • Phone: 415-275-1573
  • Fax: 650-523-4759
Mailing address:
  • Phone: 415-275-1573
  • Fax: 650-523-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC12244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: