MEDICARE: DR. MARGUERITE B. MAGUIRE MD, APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1780408526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARGUERITE B. MAGUIRE MD, APC

Provider Business Mailing Address
First Line	:	1235 SE DIVISION ST STE 203B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10323 SANTA MONICA BLVD STE 11
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6071
Country	:	US
Telephone Number	:	323-897-1125
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MARGUERITE MAGUIRE
Credential	:	MD
Telephone Number	:	323-897-1125

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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