Provider Demographics
NPI:1285988212
Name:MEENEGHAN, STEPHEN VINCENT LEE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VINCENT LEE
Last Name:MEENEGHAN
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 CORRALITAS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-4005
Mailing Address - Country:US
Mailing Address - Phone:503-724-1043
Mailing Address - Fax:
Practice Address - Street 1:4515 SHERMAN OAKS AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3820
Practice Address - Country:US
Practice Address - Phone:760-932-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15817171100000X
CA633175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist