Healthcare Provider Details

I. General information

NPI: 1932405156
Provider Name (Legal Business Name): LEONEL EDU MAGARRO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 UNIVERSITY AVE
RIVERSIDE CA
92507-5202
US

IV. Provider business mailing address

1251 S MEADOW LN APT 170
COLTON CA
92324-6443
US

V. Phone/Fax

Practice location:
  • Phone: 951-213-3450
  • Fax: 951-213-3449
Mailing address:
  • Phone: 909-433-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: