Basic Information
| Provider Information | |||||||||
| NPI: | 1871019745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGANA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JOHN ERIC | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 KENMASS AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956034719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167558050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12183 LOCKSLEY LN | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956022004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308851961 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.