Provider Demographics
NPI:1982220745
Name:LOVE, MEAGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 RUPERTUS DR
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2565
Mailing Address - Country:US
Mailing Address - Phone:904-554-2348
Mailing Address - Fax:
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4686
Practice Address - Country:US
Practice Address - Phone:714-647-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10247363AM0700X
CAPA62572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical