Provider Demographics
NPI:1306049267
Name:MAGINAS, MARY CHRISTINE (CNP, RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:MAGINAS
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:TIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, RN
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-8801
Mailing Address - Fax:858-966-7508
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-8801
Practice Address - Fax:858-966-7508
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191418-2363LP0200X, 163W00000X
CANP17231363L00000X
CARN698472163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse