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General NPI Number Information
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NPI Number | 1477110666
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Entity Type | Individual
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Provider Name | MR. ISIDRO MAGANA JR.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 2003 W JULIEANN AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-7542
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Country | US
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Telephone | 559-544-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 W JULIEANN AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-7542
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Country | US
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Telephone | 559-544-8295
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | A8056497
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License Number State | CA
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