Healthcare Provider Details

I. General information

NPI: 1790264588
Provider Name (Legal Business Name): BEN MAGUERRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16851 SIMONDS ST
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6701
US

V. Phone/Fax

Practice location:
  • Phone: 818-974-8084
  • Fax:
Mailing address:
  • Phone: 818-719-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number18693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: