Provider Demographics
NPI:1285185272
Name:BENJAMIN MAGGA ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BENJAMIN MAGGA ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-970-6321
Mailing Address - Street 1:4203 SE HAWTHORNE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3160
Mailing Address - Country:US
Mailing Address - Phone:503-970-6321
Mailing Address - Fax:
Practice Address - Street 1:4203 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3160
Practice Address - Country:US
Practice Address - Phone:503-970-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty