Provider Demographics
NPI:1841246311
Name:MAGNUSSON, AMY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:MAGNUSSON
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 1:4641 FINSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2707
Mailing Address - Country:US
Mailing Address - Phone:858-320-0505
Mailing Address - Fax:
Practice Address - Street 1:2999 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2762
Practice Address - Country:US
Practice Address - Phone:858-939-4496
Practice Address - Fax:858-939-4440
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066528208100000X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH41243Medicare UPIN