Provider Demographics
NPI:1649012477
Name:MAGNABLOOM LLC
Entity type:Organization
Organization Name:MAGNABLOOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAPITUPULU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-975-4532
Mailing Address - Street 1:1403 LOMITA BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2085
Mailing Address - Country:US
Mailing Address - Phone:424-482-8789
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2085
Practice Address - Country:US
Practice Address - Phone:424-482-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory