Provider Demographics
NPI:1679063481
Name:MEGEL, ANDREA (RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MEGEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42716 71ST ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7441
Mailing Address - Country:US
Mailing Address - Phone:661-483-0346
Mailing Address - Fax:
Practice Address - Street 1:42716 71ST ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7441
Practice Address - Country:US
Practice Address - Phone:661-483-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
934327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered