Provider Demographics
NPI:1235493057
Name:MAGANA, GUADALUPE MARIA (RDA)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MARIA
Last Name:MAGANA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:MARIA
Other - Last Name:BANUELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:11229 KLINGERMAN ST
Mailing Address - Street 2:APT 3
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2826
Mailing Address - Country:US
Mailing Address - Phone:951-662-2316
Mailing Address - Fax:
Practice Address - Street 1:14525 LAKEWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3638
Practice Address - Country:US
Practice Address - Phone:562-272-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA69102126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant