Healthcare Provider Details

I. General information

NPI: 1083539647
Provider Name (Legal Business Name): MAGNA MEDICAL AND DIAGNOSTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W 20TH AVE STE 108
HIALEAH FL
33016-1895
US

IV. Provider business mailing address

7600 W 20TH AVE STE 108
HIALEAH FL
33016-1895
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-9828
  • Fax: 786-353-9837
Mailing address:
  • Phone: 786-353-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MAGALY PINO
Title or Position: OWNER
Credential:
Phone: 786-445-1988