MEDICARE: MAGA MEDICAL CENTER CORP

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1235822271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGA MEDICAL CENTER CORP

Provider Business Mailing Address
First Line	:	7819 N DALE MABRY HWY STE 210
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3221
Country	:	US
Telephone Number	:	813-450-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	7819 N DALE MABRY HWY STE 210
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3221
Country	:	US
Telephone Number	:	813-450-1031
Fax Number	:	813-450-1039

Authorized Official
Title or Position	:	OWNER
Name	:	YOAN GONZALEZ
Credential	:
Telephone Number	:	813-450-1031

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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Directions to “MAGA MEDICAL CENTER CORP ” Practice Location

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