Provider Demographics
NPI:1245798446
Name:PEGGY G MAGNUSSON DPM INC
Entity Type:Organization
Organization Name:PEGGY G MAGNUSSON DPM INC
Other - Org Name:FOOT CARE AT HOME, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:MAGNUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-245-2789
Mailing Address - Street 1:2850 ARTESIA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3413
Mailing Address - Country:US
Mailing Address - Phone:424-257-5241
Mailing Address - Fax:866-257-3292
Practice Address - Street 1:2850 ARTESIA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3413
Practice Address - Country:US
Practice Address - Phone:424-257-5241
Practice Address - Fax:866-257-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty