Healthcare Provider Details

I. General information

NPI: 1316503741
Provider Name (Legal Business Name): ALEXIS MICHELLE MAGILL HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR STE 402
BURBANK CA
91505-5301
US

IV. Provider business mailing address

5555 GARDEN GROVE BLVD STE 200
WESTMINSTER CA
92683-8234
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-4069
  • Fax:
Mailing address:
  • Phone: 714-898-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: