Provider Demographics
NPI:1588070569
Name:MAGANA, MARIA (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MAGANA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2150
Mailing Address - Country:US
Mailing Address - Phone:831-757-1264
Mailing Address - Fax:831-757-4812
Practice Address - Street 1:950 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905
Practice Address - Country:US
Practice Address - Phone:831-757-1264
Practice Address - Fax:831-757-4812
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8466T152W00000X
CA15324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX1124091-04Medicaid