Healthcare Provider Details

I. General information

NPI: 1790117760
Provider Name (Legal Business Name): CARLOS RAMON MAGANA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E COVINA BLVD
COVINA CA
91724-1523
US

IV. Provider business mailing address

8549 SALINA ST
RANCHO CUCAMONGA CA
91730-4329
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-5298
  • Fax:
Mailing address:
  • Phone: 626-859-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT36734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: