Healthcare Provider Details

I. General information

NPI: 1750748083
Provider Name (Legal Business Name): PEGGY MAGARIAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date: 01/17/2018
Reactivation Date: 12/06/2019

III. Provider practice location address

3115 FOOTHILL BLVD STE M237
LA CRESCENTA CA
91214-2691
US

IV. Provider business mailing address

3115 FOOTHILL BLVD STE M237
LA CRESCENTA CA
91214-2691
US

V. Phone/Fax

Practice location:
  • Phone: 818-659-5801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT 13389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: