Provider Demographics
NPI:1063983831
Name:FEAGAN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FEAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 LA JOLLA BLVD UNIT B104
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7665
Mailing Address - Country:US
Mailing Address - Phone:144-091-5490
Mailing Address - Fax:
Practice Address - Street 1:5420 LA JOLLA BLVD UNIT B104
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7665
Practice Address - Country:US
Practice Address - Phone:440-915-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1029175F00000X
CA1029175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath