Provider Demographics
NPI:1336373117
Name:RHOADES, MEAGAN SHEA
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:SHEA
Last Name:RHOADES
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 1:600 B ST #1570
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101
Mailing Address - Country:US
Mailing Address - Phone:619-615-0439
Mailing Address - Fax:
Practice Address - Street 1:5332 JACKSON DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3040
Practice Address - Country:US
Practice Address - Phone:619-416-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2023-06-16
Deactivation Date:2021-04-04
Deactivation Code:
Reactivation Date:2021-05-03
Provider Licenses
StateLicense IDTaxonomies
IA7228104100000X
CARU95244615163WP0809X
CA95024626363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult