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General NPI Number Information
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NPI Number | 1134324585
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Entity Type | Individual
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Provider Name | MICHAEL MAGNOTTI MD, FACE, ECNU
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Gender | Male
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Dates
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Enumeration Date | 06/17/2007
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 3883 AIRWAY DR STE 201
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City | SANTA ROSA
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State | CA
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Zip | 95403-1671
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Country | US
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Telephone | 707-521-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 3883 AIRWAY DR STE 201
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City | SANTA ROSA
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State | CA
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Zip | 95403-1671
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 230550
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA08281000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 149159
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License Number State | CA
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