Provider Demographics
NPI:1942497920
Name:MAGILL, STEPHAN M (CPO)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:M
Last Name:MAGILL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:295 W CROMWELL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6167
Mailing Address - Country:US
Mailing Address - Phone:559-493-5020
Mailing Address - Fax:559-492-3569
Practice Address - Street 1:295 W CROMWELL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6167
Practice Address - Country:US
Practice Address - Phone:559-493-5020
Practice Address - Fax:559-492-3569
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2015-04-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist