Provider Demographics
NPI:1386640720
Name:MAGGIO, AUGUST J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:J
Last Name:MAGGIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AUGUST
Other - Middle Name:J
Other - Last Name:MAGGIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2011 MUNTON CIR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6734
Mailing Address - Country:US
Mailing Address - Phone:714-323-5243
Mailing Address - Fax:
Practice Address - Street 1:2011 MUNTON CIR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6734
Practice Address - Country:US
Practice Address - Phone:714-323-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30074208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB245237Medicare PIN
CAA44280Medicare UPIN