Healthcare Provider Details

I. General information

NPI: 1174649818
Provider Name (Legal Business Name): PEGGY DAGLIAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT ST
PASADENA CA
91105-4025
US

IV. Provider business mailing address

300 E PROVIDENCIA AVE # 109
BURBANK CA
91502-2791
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-4221
  • Fax:
Mailing address:
  • Phone: 818-468-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: