Provider Demographics
NPI:1750748083
Name:MAGARIAN, PEGGY (OTR/L)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MAGARIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 FOOTHILL BLVD STE M237
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 FOOTHILL BLVD STE M237
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2691
Practice Address - Country:US
Practice Address - Phone:818-659-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2019-12-06
Deactivation Date:2018-01-17
Deactivation Code:
Reactivation Date:2019-12-06
Provider Licenses
StateLicense IDTaxonomies
CAOT 13389314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility