Healthcare Provider Details

I. General information

NPI: 1952325292
Provider Name (Legal Business Name): TOMAS ANTONIO MAGANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMAS ANTONY MAGANA M.D.

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16335 E. 14TH ST.
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-4567
  • Fax:
Mailing address:
  • Phone: 510-535-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA65684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: