MEDICARE: MAGNA MEDICAL CORPORATION

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1083826366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNA MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	11755 VICTORY BLVD
Second Line	:	SUITE 206
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	818-762-9883
Fax Number	:	818-762-3237

Provider Business Practice Location Address
First Line	:	11755 VICTORY BLVD
Second Line	:	SUITE 206
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	818-762-9883
Fax Number	:	818-762-3237

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MANOLITO SOSA BUENDIA
Credential	:	M.D.
Telephone Number	:	818-762-9883

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	04/27/2009

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