Provider Demographics
NPI:1376800110
Name:MAGAVI, LEELA RAVI (MD)
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:RAVI
Last Name:MAGAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-974-4988
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:366 SAN MIGUEL DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7810
Practice Address - Country:US
Practice Address - Phone:919-999-4120
Practice Address - Fax:949-999-1698
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1360452084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry