MEDICARE: KHAREZA MAGNO

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	124Q00000X	Dental Hygienist	28622	CA

General Provider Information

NPI Number	:	1942687942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAREZA MAGNO

Provider Business Mailing Address
First Line	:	8266 STATION VILLAGE LN APT 2610
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5590
Country	:	US
Telephone Number	:	619-362-5903
Fax Number	:

Provider Business Practice Location Address
First Line	:	5059 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3348
Country	:	US
Telephone Number	:	619-583-7720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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Directions to “ KHAREZA MAGNO ” Practice Location

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