Healthcare Provider Details

I. General information

NPI: 1174818280
Provider Name (Legal Business Name): MEGAN MCELROY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 SANTA MONICA BLVD FL 2
WEST HOLLYWOOD CA
90069-4496
US

IV. Provider business mailing address

8550 SANTA MONICA BLVD FL 2
WEST HOLLYWOOD CA
90069-4496
US

V. Phone/Fax

Practice location:
  • Phone: 909-962-1260
  • Fax:
Mailing address:
  • Phone: 909-962-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: