Provider Demographics
NPI:1699226712
Name:BAIN, PEGGY (DVM, MPH, DACVPM)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:DVM, MPH, DACVPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53560 HULL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92152-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49620 BELUGA RD
Practice Address - Street 2:BLDG 194, RM 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92152-6505
Practice Address - Country:US
Practice Address - Phone:619-553-1869
Practice Address - Fax:619-553-6295
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19157171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19157OtherVETERINARY LICENSE