Provider Demographics
NPI:1457334096
Name:MAGANA, LORENA MAGANA (PA-C)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:MAGANA
Last Name:MAGANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:MAGANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3605 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5173
Mailing Address - Country:US
Mailing Address - Phone:209-381-2000
Mailing Address - Fax:209-384-2341
Practice Address - Street 1:3605 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-381-2000
Practice Address - Fax:209-384-2341
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15716363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1048610OtherNCCPA #
CA1048610OtherNCCPA #
CAMM0663080OtherDEA CERT