Healthcare Provider Details

I. General information

NPI: 1174199475
Provider Name (Legal Business Name): PATRICIA Q MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N 30TH AVE UNIT 1
PHOENIX AZ
85009-5001
US

IV. Provider business mailing address

123 N 30TH AVE UNIT 1
PHOENIX AZ
85009-5001
US

V. Phone/Fax

Practice location:
  • Phone: 862-227-2630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: