Healthcare Provider Details

I. General information

NPI: 1558257303
Provider Name (Legal Business Name): MEGAN SOPHIE LA ROSE MS, RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2947 CAMINO PIEDRA LUMBRE
SANTA FE NM
87505-5379
US

IV. Provider business mailing address

2947 CAMINO PIEDRA LUMBRE
SANTA FE NM
87505-5379
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-9286
  • Fax:
Mailing address:
  • Phone: 310-733-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: