1184514721 NPI number — MEAGHAN STICH

Table of content: MEAGHAN STICH (NPI 1184514721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184514721 NPI number — MEAGHAN STICH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STICH
Provider First Name:
MEAGHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184514721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18218 W PURDUE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADDELL
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85355-4239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-918-0317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LEAFWING CENTER 2127 W. ORANGEWOOD AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-634-8500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)