Healthcare Provider Details

I. General information

NPI: 1326458993
Provider Name (Legal Business Name): NICHELLE MEGOWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. CARSON STREET,
TORRANCE CA
90509-2910
US

IV. Provider business mailing address

BOX 400 1000 W. CARSON STREET,
TORRANCE CA
90509-2910
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2401
  • Fax:
Mailing address:
  • Phone: 310-222-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA137661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: