Provider Demographics
NPI:1073212239
Name:JUSTICE, MEEGAN LEE
Entity Type:Individual
Prefix:
First Name:MEEGAN
Middle Name:LEE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7875 BLUE MOON RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6346
Mailing Address - Country:US
Mailing Address - Phone:805-904-9782
Mailing Address - Fax:805-360-4050
Practice Address - Street 1:7875 BLUE MOON RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-6346
Practice Address - Country:US
Practice Address - Phone:805-904-9782
Practice Address - Fax:805-360-4050
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86104196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered