Healthcare Provider Details

I. General information

NPI: 1982996294
Provider Name (Legal Business Name): CUAUHTEMOC MAGANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROLLING OAKS DR
THOUSAND OAKS CA
91361-1275
US

IV. Provider business mailing address

351 ROLLING OAKS DR
THOUSAND OAKS CA
91361-1275
US

V. Phone/Fax

Practice location:
  • Phone: 805-373-8582
  • Fax:
Mailing address:
  • Phone: 805-373-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA119778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: