Provider Demographics
NPI:1538559976
Name:DAGLIAN, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DAGLIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 MATILIJA AVE STE 205
Mailing Address - Street 2:VAN NUYS
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1576
Mailing Address - Country:US
Mailing Address - Phone:877-505-5525
Mailing Address - Fax:818-842-5822
Practice Address - Street 1:6412 MATILIJA AVE #205
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:877-505-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0025663343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)