Healthcare Provider Details

I. General information

NPI: 1114458346
Provider Name (Legal Business Name): MAGMA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY
BEVERLY HILLS CA
90210-4714
US

IV. Provider business mailing address

9400 BRIGHTON WAY
BEVERLY HILLS CA
90210-4714
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-0144
  • Fax: 310-275-5470
Mailing address:
  • Phone: 310-274-0144
  • Fax: 310-275-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 55620
License Number StateCA

VIII. Authorized Official

Name: E YADIDI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 310-274-0144