Provider Demographics
NPI:1205984689
Name:MAGINA, FATIMA C (MD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:C
Last Name:MAGINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MAGNOLIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3128
Mailing Address - Country:US
Mailing Address - Phone:951-278-2530
Mailing Address - Fax:951-278-9746
Practice Address - Street 1:830 MAGNOLIA AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3128
Practice Address - Country:US
Practice Address - Phone:951-278-2530
Practice Address - Fax:951-278-9746
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97808208D00000X, 305R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA97808Medicare UPIN