Provider Demographics
NPI:1699176636
Name:POSTNIKOFF, PEGGY SUSAN
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUSAN
Last Name:POSTNIKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 1/2 PULLMAN LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4124
Mailing Address - Country:US
Mailing Address - Phone:626-202-5951
Mailing Address - Fax:
Practice Address - Street 1:1814 1/2 PULLMAN LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4124
Practice Address - Country:US
Practice Address - Phone:626-202-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies