Healthcare Provider Details

I. General information

NPI: 1013545011
Provider Name (Legal Business Name): ISABELLE LAURENCE MAGRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD STE 7200
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2521 STOCKTON BLVD STE 7200
SACRAMENTO CA
95817-2207
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2801
  • Fax: 916-703-5011
Mailing address:
  • Phone: 916-734-2801
  • Fax: 916-703-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA187302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: