Provider Demographics
NPI:1235822271
Name:MAGA MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:MAGA MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-450-1031
Mailing Address - Street 1:7819 N DALE MABRY HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3221
Mailing Address - Country:US
Mailing Address - Phone:813-450-1031
Mailing Address - Fax:
Practice Address - Street 1:7819 N DALE MABRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3221
Practice Address - Country:US
Practice Address - Phone:813-450-1031
Practice Address - Fax:813-450-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty