Provider Demographics
NPI:1093588824
Name:SWEENEY, MEGAN MACKENZIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MACKENZIE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N PAULINA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3020
Mailing Address - Country:US
Mailing Address - Phone:619-261-0188
Mailing Address - Fax:
Practice Address - Street 1:11130 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1729
Practice Address - Country:US
Practice Address - Phone:619-261-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program