Provider Demographics
NPI:1871690594
Name:MAGY, MARTIN A (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:MAGY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:ALAN
Other - Last Name:MAGY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:380 S MELROSE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6652
Mailing Address - Country:US
Mailing Address - Phone:760-941-6062
Mailing Address - Fax:760-726-3509
Practice Address - Street 1:380 S MELROSE DR STE 210
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6652
Practice Address - Country:US
Practice Address - Phone:760-941-6062
Practice Address - Fax:760-726-3509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6728103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R26517Medicare UPIN
CACP6728Medicare ID - Type Unspecified