Provider Demographics
NPI:1871994954
Name:CLARKE-DIMAQUIBO, MEGAN A (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:CLARKE-DIMAQUIBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1130
Mailing Address - Country:US
Mailing Address - Phone:858-300-0460
Mailing Address - Fax:858-300-0461
Practice Address - Street 1:7155 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1130
Practice Address - Country:US
Practice Address - Phone:858-300-0460
Practice Address - Fax:858-300-0461
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA837487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse