Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC29523 | CA |
N | 111NN1001X | Nutrition | DC29523 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC29523 | CA |
N | 111NX0100X | Occupational Health | DC29523 | CA |
NPI | 1649292608 |
---|---|
Provider Name | Dr. Maggie Pezeshkian |
First Address | Duarte, CA 91010-1779 |
Second Address | Duarte, CA 91010-1779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V04554 | (02) | CA |