Provider Demographics
NPI:1932618287
Name:MIRAMONTES, MEGAN LEE (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEE
Last Name:MIRAMONTES
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:MIRAMONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:910 E FLORIDA AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4508
Mailing Address - Country:US
Mailing Address - Phone:951-492-8229
Mailing Address - Fax:
Practice Address - Street 1:910 E FLORIDA AVE STE B2
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4508
Practice Address - Country:US
Practice Address - Phone:951-492-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17547171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist