Basic Information
| Provider Information | |||||||||
| NPI: | 1649362955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HESSER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 712682 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900717682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056809511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13160 MINDANAO WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105740400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 04/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA18547 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA18547 | 01 | CA | MED LICENSE | OTHER |