Provider Demographics
NPI:1487100236
Name:MAGUIRE, MARGUERITE (MD)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 EL CAMINO REAL
Mailing Address - Street 2:STE 224
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1458
Mailing Address - Country:US
Mailing Address - Phone:650-690-2362
Mailing Address - Fax:650-590-4938
Practice Address - Street 1:2444 WILSHIRE BLVD STE 414
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5811
Practice Address - Country:US
Practice Address - Phone:323-340-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1482552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program