Healthcare Provider Details

I. General information

NPI: 1043577422
Provider Name (Legal Business Name): MS. MARIBEL MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE SUITE # 601
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

510 S VERMONT AVE FL 17
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-351-7284
  • Fax: 213-427-6161
Mailing address:
  • Phone: 213-351-7284
  • Fax: 213-947-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: