Basic Information
| Provider Information | |||||||||
| NPI: | 1538621149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10790 RANCHO BERNARDO RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921275705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197137880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 278 TOWN CENTER PKWY STE 105S90 | ||||||||
| Address2: | |||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920715800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197137880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A178909 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.