Provider Demographics
NPI:1184779522
Name:MCCORMICK, MARGUERITE MARY (NP)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:MARY
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2340 PLAZA DEL AMO
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3445
Mailing Address - Country:US
Mailing Address - Phone:310-781-1414
Mailing Address - Fax:310-781-1424
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-372-1156
Practice Address - Fax:310-781-1424
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner