Provider Demographics
NPI:1790840726
Name:MAGID, ROLA NABIL (MD)
Entity Type:Individual
Prefix:
First Name:ROLA
Middle Name:NABIL
Last Name:MAGID
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 1:1601 EASTMAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6481
Mailing Address - Country:US
Mailing Address - Phone:805-658-0113
Mailing Address - Fax:805-642-7544
Practice Address - Street 1:1601 EASTMAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6481
Practice Address - Country:US
Practice Address - Phone:805-658-0113
Practice Address - Fax:805-642-7544
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67969208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CZ135AOtherPTAN
CAWA679695Medicare ID - Type Unspecified
CZ135AOtherPTAN