Healthcare Provider Details

I. General information

NPI: 1063353134
Provider Name (Legal Business Name): MEGAN LA FUENTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 SANTA MONICA BLVD STE 101
WEST HOLLYWOOD CA
90069-4498
US

IV. Provider business mailing address

1915 BRENTWOOD DR
FULLERTON CA
92831-1016
US

V. Phone/Fax

Practice location:
  • Phone: 310-912-7271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: