Provider Demographics
NPI:1629564869
Name:HOM, MEGAN ELIZABETH (DPM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:HOM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EQUESTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2600
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:2272 BACON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2022
Practice Address - Country:US
Practice Address - Phone:925-676-3933
Practice Address - Fax:925-609-7255
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL6827213E00000X
CAE5663213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist