Provider Demographics
NPI:1700083540
Name:FAGUNDES, MEGHAN (MS, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:FAGUNDES
Suffix:
Gender:F
Credentials:MS, MA, PHD
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 16753
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-6753
Mailing Address - Country:US
Mailing Address - Phone:858-634-0456
Mailing Address - Fax:
Practice Address - Street 1:8765 AERO DR STE 228
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1785
Practice Address - Country:US
Practice Address - Phone:858-876-7779
Practice Address - Fax:619-272-7542
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53683106H00000X
CAPSY31947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist