MEDICARE: DR. PEGGY BAIN DVM, MPH, DACVPM

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	171000000X	Military Health Care Provider	19157	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19157	OTHER	CA	VETERINARY LICENSE

General Provider Information

NPI Number	:	1699226712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEGGY BAIN DVM, MPH, DACVPM

Provider Business Mailing Address
First Line	:	53560 HULL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92152-5001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	49620 BELUGA RD
Second Line	:	BLDG 194, RM 111
City	:	SAN DIEGO
State	:	CA
Zip	:	92152-6505
Country	:	US
Telephone Number	:	619-553-1869
Fax Number	:	619-553-6295

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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