Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | PSY8851 | CA |
NPI | 1447482815 |
---|---|
Provider Name | John R Magner |
First Address | Riverside, CA 92505-3043 |
Second Address | Riverside, CA 92505-3043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |