1255106084 NPI number — MAGNA PDC PLLC

Table of content: ADRIAN AUGUST ISAZA DC (NPI 1326537820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255106084 NPI number — MAGNA PDC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAGNA PDC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255106084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84097-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-691-1701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9010 W MAGNA MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGNA
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84044-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-250-7311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHRISTENSEN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
801-691-1701

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)