Basic Information
| Provider Information | |||||||||
| NPI: | 1972764017 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SEAGO | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10666 N TORREY PINES RD # MS 112A | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585548646 | ||||||||
| FaxNumber: | 8585546271 | ||||||||
| Practice Location | |||||||||
| Address1: | NMCSD DERMATOLOGY | ||||||||
| Address2: | 34520 BOB WILSON DR SUITE 300 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921342300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192517676 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | C151892 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 0101245988 | VA | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | C151892 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.