Provider Demographics
NPI:1972076016
Name:MAGPANTAY, MELCHOR GABUNA (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MELCHOR
Middle Name:GABUNA
Last Name:MAGPANTAY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 WOODMAN AVE APT A108
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5562
Mailing Address - Country:US
Mailing Address - Phone:661-755-3955
Mailing Address - Fax:
Practice Address - Street 1:4498 WOODMAN AVE APT A108
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5562
Practice Address - Country:US
Practice Address - Phone:661-755-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily