Provider Demographics
NPI:1841206471
Name:MAGINOT, ANDRE E (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:E
Last Name:MAGINOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:#201 VASCULAR & GENERAL SURGERY ASSOC
Mailing Address - City:LAS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-596-5387
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:#201 VASCULAR & GENERAL SURGERY ASSOC
Practice Address - City:LAS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-596-5387
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43894208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G438940Medicaid
A92446Medicare UPIN
CAWG43894AMedicare ID - Type Unspecified