Provider Demographics
NPI:1053884916
Name:ALLARD, MEAGAN ALEXANDRA (PA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ALEXANDRA
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BAKER ST APT D206
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4476
Mailing Address - Country:US
Mailing Address - Phone:603-496-7911
Mailing Address - Fax:
Practice Address - Street 1:655 BAKER ST APT D206
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4476
Practice Address - Country:US
Practice Address - Phone:603-496-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty