Provider Demographics
NPI:1790117760
Name:MAGANA, CARLOS RAMON JR
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAMON
Last Name:MAGANA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9903 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4614
Mailing Address - Country:US
Mailing Address - Phone:714-914-9098
Mailing Address - Fax:
Practice Address - Street 1:1007 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4521
Practice Address - Country:US
Practice Address - Phone:626-808-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36734167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician