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General NPI Number Information
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NPI Number | 1619002821
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Entity Type | Individual
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Provider Name | PEGGY GRAY MAGNUSSON D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 2850 ARTESIA BLVD #204
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3419
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Country | US
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Telephone | 310-545-9445
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Fax | 310-545-4998
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Provider Business Mailing Address
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Address Line | 2850 ARTESIA BLVD #204
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3419
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Country | US
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Telephone | 310-245-2789
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Fax | 866-257-3292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E2343
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License Number State | CA
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