Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | M16920 | CA |
N | 103T00000X | Psychologist | M16920 | CA |
NPI | 1013920610 |
---|---|
Provider Name | Peggy L Irwin |
First Address | Studio City, CA 91604 |
Second Address | Studio City, CA 91604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |