Provider Demographics
NPI:1972991149
Name:WROE, MEGAN SOMERVILLE (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:SOMERVILLE
Last Name:WROE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALYSSA
Other - Last Name:SOMERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:100 E VALENCIA MESA DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3813
Mailing Address - Country:US
Mailing Address - Phone:714-446-5677
Mailing Address - Fax:714-446-5619
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 111
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-446-5677
Practice Address - Fax:714-446-5619
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1099988133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered