Provider Demographics
NPI:1427363787
Name:MAGOTO, MANDY ANN (DPT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:ANN
Last Name:MAGOTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E LAMBERT RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4370
Mailing Address - Country:US
Mailing Address - Phone:714-256-5074
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAMBERT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4370
Practice Address - Country:US
Practice Address - Phone:714-256-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic