Basic Information
| Provider Information | |||||||||
| NPI: | 1851572119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRIGAN | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E LAKE DR UNIT 66 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928662758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146289346 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 W 17TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927062316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148347763 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 446392 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 163XC1500X | 05 | CA | MEDICAID |