Provider Demographics
NPI:1912307208
Name:MAGED M ESTAFAN MD INC
Entity Type:Organization
Organization Name:MAGED M ESTAFAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTAFAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-302-7085
Mailing Address - Street 1:31915 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5132
Mailing Address - Country:US
Mailing Address - Phone:951-302-7085
Mailing Address - Fax:951-302-7673
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:951-302-7085
Practice Address - Fax:951-302-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC529422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty