1740484633 NPI number — PERSONALCARE PHYSICIANS OF NEWPORT BEACH INC

Table of content: DR. TRACY LEE MAGERUS NMD (NPI 1467695742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740484633 NPI number — PERSONALCARE PHYSICIANS OF NEWPORT BEACH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONALCARE PHYSICIANS OF NEWPORT BEACH INC
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:
1740484633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 E COAST HWY STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA DEL MAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92625-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-706-3300
Provider Business Mailing Address Fax Number:
949-706-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E COAST HWY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA DEL MAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92625-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-706-3300
Provider Business Practice Location Address Fax Number:
949-706-3301
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHENG
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
949-706-3300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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