Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | AFE27655 | CA |
NPI | 1023374881 |
---|---|
Provider Name | Dr. Sue A. Magara |
First Address | Rolling Hills, CA 90274-5230 |
Second Address | Rolling Hills, CA 90274-5230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 05/04/2012 |