Provider Demographics
NPI:1083826366
Name:MAGNA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MAGNA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOLITO
Authorized Official - Middle Name:SOSA
Authorized Official - Last Name:BUENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-762-9883
Mailing Address - Street 1:11755 VICTORY BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:818-762-9883
Mailing Address - Fax:818-762-3237
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:818-762-9883
Practice Address - Fax:818-762-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty