Basic Information
| Provider Information | |||||||||
| NPI: | 1992778989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEEHAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26522 LA ALAMEDA | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492821671 | ||||||||
| FaxNumber: | 9493670518 | ||||||||
| Practice Location | |||||||||
| Address1: | 27231 LA PAZ RD | ||||||||
| Address2: | # A | ||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926773627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496439111 | ||||||||
| FaxNumber: | 9496438916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | G39663 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.