Healthcare Provider Details

I. General information

NPI: 1982921797
Provider Name (Legal Business Name): KATHY ELIZABETH MAGLIATO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EL MEDIO AVE
PACIFIC PALISADES CA
90272-4220
US

IV. Provider business mailing address

401 EL MEDIO AVE
PACIFIC PALISADES CA
90272-4220
US

V. Phone/Fax

Practice location:
  • Phone: 310-291-7128
  • Fax:
Mailing address:
  • Phone: 310-291-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG85331
License Number StateCA

VIII. Authorized Official

Name: DR. KATHY ELIZABETH MAGLIATO
Title or Position: PRESIDENT
Credential: MD
Phone: 310-291-7128