Provider Demographics
NPI:1386257400
Name:CONNOLLY, MEGAN CAROLYN (RD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CAROLYN
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LA MACARENA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9126
Mailing Address - Country:US
Mailing Address - Phone:562-233-9471
Mailing Address - Fax:
Practice Address - Street 1:2501 LA MACARENA AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-9126
Practice Address - Country:US
Practice Address - Phone:562-233-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered