Provider Demographics
NPI:1023374881
Name:MAGARA, SUE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:A
Last Name:MAGARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAVERICK LN
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5230
Mailing Address - Country:US
Mailing Address - Phone:310-377-3292
Mailing Address - Fax:
Practice Address - Street 1:3 MAVERICK LN
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS
Practice Address - State:CA
Practice Address - Zip Code:90274-5230
Practice Address - Country:US
Practice Address - Phone:310-377-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE27655208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice