1558521583 NPI number — AMY FRANCIS TODD MAGNUSON M.D.

Table of content: AMY FRANCIS TODD MAGNUSON M.D. (NPI 1558521583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558521583 NPI number — AMY FRANCIS TODD MAGNUSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGNUSON
Provider First Name:
AMY
Provider Middle Name:
FRANCIS TODD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSSO
Provider Other First Name:
AMY
Provider Other Middle Name:
FRANCIS TODD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558521583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10790 RANCHO BERNARDO RD
Provider Second Line Business Mailing Address:
MAIL DROP 4S-205
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92127-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-806-5820
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CEDAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-806-5820
Provider Business Practice Location Address Fax Number:
760-945-2052
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C 144685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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