Provider Demographics
NPI:1033999073
Name:MAGNIFICARE LLC
Entity Type:Organization
Organization Name:MAGNIFICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ARCEGA
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-300-6740
Mailing Address - Street 1:719 BARRIS DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1001
Mailing Address - Country:US
Mailing Address - Phone:949-300-6740
Mailing Address - Fax:
Practice Address - Street 1:1440 N HARBOR BLVD STE 900
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4122
Practice Address - Country:US
Practice Address - Phone:949-300-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care