Provider Demographics
NPI:1649292608
Name:PEZESHKIAN, MAGGIE (DC)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:PEZESHKIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 BUENA VISTA ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1779
Mailing Address - Country:US
Mailing Address - Phone:626-359-3956
Mailing Address - Fax:626-359-3247
Practice Address - Street 1:924 BUENA VISTA ST
Practice Address - Street 2:STE. 103
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1779
Practice Address - Country:US
Practice Address - Phone:626-359-3956
Practice Address - Fax:626-359-3247
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29523111NN1001X, 111NS0005X, 111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04554Medicare UPIN