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NPI Code Detail

MEDICARE: MEGAN COLLEEN LEAVEY

MEDICARE:   MEGAN COLLEEN LEAVEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1982383006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN COLLEEN LEAVEY
Provider Business Mailing Address
First Line : 4356 W POINT LOMA BLVD APT N
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-1172
Country : US
Telephone Number : 757-903-1836
Fax Number :
Provider Business Practice Location Address
First Line : 4356 W POINT LOMA BLVD APT N
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-1172
Country : US
Telephone Number : 757-903-1836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2023
Last Update Date : 07/17/2023

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Directions to “ MEGAN COLLEEN LEAVEY ” Practice Location

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