Provider Demographics
NPI:1619743457
Name:PURDY, MAGNALAINA LEE BLUE
Entity Type:Individual
Prefix:
First Name:MAGNALAINA LEE
Middle Name:BLUE
Last Name:PURDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S OLIVE ST APT 433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4226
Mailing Address - Country:US
Mailing Address - Phone:858-716-7424
Mailing Address - Fax:
Practice Address - Street 1:1001 S OLIVE ST APT 433
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4226
Practice Address - Country:US
Practice Address - Phone:858-716-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health