Provider Demographics
NPI:1780964064
Name:GRUNDBERG, MEAGEN ELIZABETH (COMMUNITY WORKER)
Entity type:Individual
Prefix:
First Name:MEAGEN
Middle Name:ELIZABETH
Last Name:GRUNDBERG
Suffix:
Gender:F
Credentials:COMMUNITY WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 INTERNATIONAL BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606
Mailing Address - Country:US
Mailing Address - Phone:347-600-1263
Mailing Address - Fax:
Practice Address - Street 1:544 INTERNATIONAL BLVD STE 9
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606
Practice Address - Country:US
Practice Address - Phone:347-600-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker