Provider Demographics
NPI:1982992509
Name:BOCHUM, MEGAN (LM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BOCHUM
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3116
Mailing Address - Country:US
Mailing Address - Phone:805-994-0446
Mailing Address - Fax:805-856-1525
Practice Address - Street 1:136 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3116
Practice Address - Country:US
Practice Address - Phone:805-994-0446
Practice Address - Fax:805-856-1525
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM299176B00000X
ZZL57467174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN