Healthcare Provider Details

I. General information

NPI: 1285813550
Provider Name (Legal Business Name): MARK MAGULAC MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 W BERNARDO CT SUITE 300
SAN DIEGO CA
92127-1641
US

IV. Provider business mailing address

PO BOX 511267
LOS ANGELES CA
90051-7822
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-3330
  • Fax: 858-487-3331
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK LYMAN MAGULAC
Title or Position: OWNER
Credential: MD
Phone: 858-487-3330