Healthcare Provider Details

I. General information

NPI: 1639479470
Provider Name (Legal Business Name): MR. MIGUEL ANGEL MAGANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIGUEL ANGEL MAGANA VENTURA MS

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BRUNDAGE LN
BAKERSFIELD CA
93304-2848
US

IV. Provider business mailing address

1901 BRUNDAGE LN
BAKERSFIELD CA
93304-2848
US

V. Phone/Fax

Practice location:
  • Phone: 661-869-1074
  • Fax: 661-869-1075
Mailing address:
  • Phone: 661-869-1074
  • Fax: 661-869-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number74892
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11416340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: