Provider Demographics
NPI:1093992380
Name:MAGU, RENU (MD)
Entity Type:Individual
Prefix:DR
First Name:RENU
Middle Name:
Last Name:MAGU
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 1:2005 COURT ST
Mailing Address - Street 2:STE N
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1807
Mailing Address - Country:US
Mailing Address - Phone:530-768-1633
Mailing Address - Fax:530-768-1634
Practice Address - Street 1:2005 COURT ST
Practice Address - Street 2:STE N
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1807
Practice Address - Country:US
Practice Address - Phone:530-768-1633
Practice Address - Fax:530-768-1634
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41757207R00000X
CAC129045207R00000X, 207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430526Medicaid