Healthcare Provider Details

I. General information

NPI: 1851572747
Provider Name (Legal Business Name): JESSENIA MAGUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 ROYAL PALM BOULEVARD SUITE 100
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

8880 ROYAL PALM BOULEVARD SUITE 100
CORAL SPRINGS FL
33065
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-2411
  • Fax: 954-753-1176
Mailing address:
  • Phone: 954-753-2411
  • Fax: 954-753-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME109091
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME109091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: