MEDICARE: MARK MAGULAC MD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1285813550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK MAGULAC MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 511267
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-7822
Country	:	US
Telephone Number	:	866-284-2771
Fax Number	:	800-334-1041

Provider Business Practice Location Address
First Line	:	11440 W BERNARDO CT
Second Line	:	SUITE 300
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1641
Country	:	US
Telephone Number	:	858-487-3330
Fax Number	:	858-487-3331

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK LYMAN MAGULAC
Credential	:	MD
Telephone Number	:	858-487-3330

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/23/2011

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