Healthcare Provider Details

I. General information

NPI: 1457334096
Provider Name (Legal Business Name): LORENA MAGANA MAGANA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORENA MAGANA PA

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 HOSPITAL RD
ATWATER CA
95301-5173
US

IV. Provider business mailing address

3605 HOSPITAL RD
ATWATER CA
95301-5173
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-2000
  • Fax: 209-384-2341
Mailing address:
  • Phone: 209-381-2000
  • Fax: 209-384-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: