Doctor Name: | DR. MEAGAN MARIE MARCUCCILLI |
NPI Number: | 1821288630 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | A100012 |
Business Practice Address: | 4870 Barranca Pkwy Ste 110 Irvine, CA - 926044787 |
Business Phone Number: | 9498571248 |
Business Fax Number: | |
Mailing Address: | Po Box 3699, NEWPORT BEACH |
State: | CA |
Postal Code: | 926598699 |
Phone Number: | 9498571248 |
Fax Number: | 9495591165 |
NPI Enumeration Date: | 07/27/2007 |
NPI Last Update Date: | 11/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A100012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |