MEDICARE: PEGGY GROVES MT-BC

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	225A00000X	Music Therapist	07800	CA

General Provider Information

NPI Number	:	1245316876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY GROVES MT-BC

Provider Business Mailing Address
First Line	:	57 POMONA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3426
Country	:	US
Telephone Number	:	714-466-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 POMONA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3426
Country	:	US
Telephone Number	:	714-466-0117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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Directions to “ PEGGY GROVES MT-BC” Practice Location

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