Provider Demographics
NPI:1447207352
Name:MAGANA, RENEE N (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:N
Last Name:MAGANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2116
Mailing Address - Country:US
Mailing Address - Phone:310-450-0600
Mailing Address - Fax:888-965-6671
Practice Address - Street 1:3306 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2116
Practice Address - Country:US
Practice Address - Phone:310-450-0600
Practice Address - Fax:888-965-6671
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83425207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A834250OtherBLUE SHIELD
CAA83425OtherBLUE CROSS
CAP00278486OtherVALLEY PRES RAILROAD
CA00A834250Medicaid
CA00A834250OtherCALOPTIMA
CA050126CI34527OtherVALLEY PRES TRAILBLAZER
CAWA83425BMedicare Oscar/Certification
CA00A834250OtherCALOPTIMA
CA00A834250OtherBLUE SHIELD