Provider Demographics
NPI:1538132048
Name:LEGAULT, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:LEGAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:55 E CALIFORNIA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3954
Practice Address - Country:US
Practice Address - Phone:626-449-7350
Practice Address - Fax:626-449-1321
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93452Medicare UPIN