Provider Demographics
NPI:1225542640
Name:MAGNO, PATRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:MAGNO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14332 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6946
Mailing Address - Country:US
Mailing Address - Phone:650-445-2542
Mailing Address - Fax:
Practice Address - Street 1:14332 CHERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6946
Practice Address - Country:US
Practice Address - Phone:650-445-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294060208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation