Provider Demographics
NPI:1245659291
Name:MAGILL, VALERIE (NPC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MAGILL
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:MAGILL
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NPC
Mailing Address - Street 1:17339 TRAMONTO DR
Mailing Address - Street 2:203
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3124
Mailing Address - Country:US
Mailing Address - Phone:310-433-6396
Mailing Address - Fax:
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-264-1777
Practice Address - Fax:310-264-1787
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWO34467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner