Provider Demographics
NPI:1902381452
Name:MAGANA, SUSANA (RDH)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:MAGANA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:SILAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:1056 BELMONT AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5937
Mailing Address - Country:US
Mailing Address - Phone:562-279-3034
Mailing Address - Fax:
Practice Address - Street 1:507 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2621
Practice Address - Country:US
Practice Address - Phone:323-268-9191
Practice Address - Fax:323-268-9119
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27501124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist