Provider Demographics
NPI:1356381073
Name:OMEEGHAN, ROSEMARY (MBCHB)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:OMEEGHAN
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749226
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9226
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-6876
Practice Address - Fax:949-764-6874
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505950Medicaid
CA00C50595OtherBLUE SHIELD OF CA
F72674Medicare UPIN
CA00C505950Medicaid
CAWC50595AMedicare PIN