Provider Demographics
NPI:1871860775
Name:MAGNO, LOIDA D
Entity Type:Individual
Prefix:
First Name:LOIDA
Middle Name:D
Last Name:MAGNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4408
Mailing Address - Country:US
Mailing Address - Phone:702-457-1048
Mailing Address - Fax:
Practice Address - Street 1:3004 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4408
Practice Address - Country:US
Practice Address - Phone:702-457-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor