Provider Demographics
NPI:1831487883
Name:MAGSINO, MIRA MAY GUTIERREZ (MD)
Entity type:Individual
Prefix:
First Name:MIRA MAY
Middle Name:GUTIERREZ
Last Name:MAGSINO
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 1:27000 W LUGONIA AVE APT 5216
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2085
Mailing Address - Country:US
Mailing Address - Phone:304-218-8071
Mailing Address - Fax:
Practice Address - Street 1:75036 GERALD FORD DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2080
Practice Address - Country:US
Practice Address - Phone:866-984-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127639207Q00000X
PAMD452614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine