Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 301938 | NY |
Y | 207X00000X | Orthopaedic Surgeon | A153913 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 301938 | NY |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A153913 | CA |
NPI | 1205324423 |
---|---|
Provider Name | Eytan Magen Debbi |
First Address | Torrance, CA 90504-5513 |
Second Address | Los Angeles, CA 90048-4165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 02/11/2021 |