Healthcare Provider Details

I. General information

NPI: 1528922986
Provider Name (Legal Business Name): MEGHAN COONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 10TH ST STE A
TRACY CA
95376-4063
US

IV. Provider business mailing address

450 ALLISHA LN
TRACY CA
95376-5127
US

V. Phone/Fax

Practice location:
  • Phone: 209-627-7667
  • Fax:
Mailing address:
  • Phone: 925-876-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: