Provider Demographics
NPI:1376767673
Name:MAGNUS, WARREN W (DO)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:W
Last Name:MAGNUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:3201 S MARYLAND PKWY STE 218
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2424
Practice Address - Country:US
Practice Address - Phone:702-862-8075
Practice Address - Fax:702-862-8077
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376767673Medicaid
NVCS11320OtherPHARMACY/CONTROLLED SUBSTANCE CERTIFICATE
NV1073OtherMEDICAL LICENSE
NV1073OtherMEDICAL LICENSE
NVBM5399844OtherDEA
NV1376767673Medicaid