Provider Demographics
NPI:1679675144
Name:MAGNO, PRISCILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:MAGNO
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 1:101 CALLE JAZMIN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6312
Mailing Address - Country:US
Mailing Address - Phone:787-344-3775
Mailing Address - Fax:
Practice Address - Street 1:CARR #18 INT 21
Practice Address - Street 2:BO. MONACILLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-936-1477
Practice Address - Fax:787-936-1491
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065053207RG0100X
PR14740207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology