Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 41757 | AZ |
N | 111NI0900X | Internist | 41757 | AZ |
Y | 207R00000X | Internist | C129045 | CA |
Y | 111NI0900X | Internist | C129045 | CA |
N | 207RG0300X | Geriatric Medicine | C129045 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | C129045 | CA |
NPI | 1093992380 |
---|---|
Provider Name | Dr. Renu Magu |
First Address | Redding, CA 96001-1807 |
Second Address | Redding, CA 96001-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
430526 | (05) | AZ |