Provider Demographics
NPI:1831637024
Name:BACKOVICH, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BACKOVICH
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 1:2248 OBISPO AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-4026
Mailing Address - Country:US
Mailing Address - Phone:213-550-2634
Mailing Address - Fax:
Practice Address - Street 1:2248 OBISPO AVE
Practice Address - Street 2:STE 202
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-4026
Practice Address - Country:US
Practice Address - Phone:213-550-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator