1760507206 NPI number — MAGNIFICAT MEDICAL CLINIC INC

Table of content: (NPI 1760507206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760507206 NPI number — MAGNIFICAT MEDICAL CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAGNIFICAT MEDICAL CLINIC 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:
1760507206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17620 BELLFLOWER BLVD
Provider Second Line Business Mailing Address:
STE B 106 & 107
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90706-8070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-867-7098
Provider Business Mailing Address Fax Number:
562-867-7146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17620 BELLFLOWER BLVD
Provider Second Line Business Practice Location Address:
STE B 106 & 107
Provider Business Practice Location Address City Name:
BELLFLOWER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90706-8070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-867-7098
Provider Business Practice Location Address Fax Number:
562-867-7146
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
JOY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
562-867-7098

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1205977246 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255372942 . This is a "MEDICAL DOCTOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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