Healthcare Provider Details

I. General information

NPI: 1588571558
Provider Name (Legal Business Name): MARTA ANNA MAGNUSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S MELROSE DR STE 100
VISTA CA
92081-6669
US

IV. Provider business mailing address

314 S MELROSE DR STE 100
VISTA CA
92081-6669
US

V. Phone/Fax

Practice location:
  • Phone: 760-500-3325
  • Fax:
Mailing address:
  • Phone: 760-500-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: