Basic Information
| Provider Information | |||||||||
| NPI: | 1386992410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGANA | ||||||||
| FirstName: | ROSALBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1162 CASA VISTA DR | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917682407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262521314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 560 S ST LOUIS ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232614900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.