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NPI Code Detail

MEDICARE: JESUS MAGNO

MEDICARE: JESUS MAGNO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor

General Provider Information

NPI Number : 1043587942
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESUS MAGNO
Provider Business Mailing Address
First Line : 3004 CEDAR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4408
Country : US
Telephone Number : 702-457-1048
Fax Number :
Provider Business Practice Location Address
First Line : 3004 CEDAR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4408
Country : US
Telephone Number : 702-457-1048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2011
Last Update Date : 11/20/2011

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1871860775 — LOIDA D MAGNO
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1316214216 — AMALIA O MAGNO
Practice Location Address:
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1174522080 — ALLYN P. GOODRICH D.D.S.
Practice Location Address:
4408 S EASTERN AVE , STE. 100
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89119-7825
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Practice Fax:

Directions to “ JESUS MAGNO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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