Provider Demographics
NPI:1437615846
Name:SPRAGUE, MARGARET MELINDA (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MELINDA
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5437
Mailing Address - Country:US
Mailing Address - Phone:858-344-7216
Mailing Address - Fax:
Practice Address - Street 1:1482 KINGS VILLA RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-1042
Practice Address - Country:US
Practice Address - Phone:760-789-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG562282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherNONE