| Mark Lyman Magulac M.d., A Professional Corporation | |
|
11440 W Bernardo Ct Suite 300 San Diego CA 92127-1641 | |
| (858) 487-3330 | |
| (858) 487-3331 |
| Full Name | Mark Lyman Magulac M.d., A Professional Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11440 W Bernardo Ct, San Diego, California |
| Authorized Official Name and Position | Mark Magulac (OWNER) |
| Authorized Official Contact | 8584873330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Lyman Magulac M.d., A Professional Corporation Po Box 511267 Los Angeles CA 90051-7822 Ph: (866) 284-2771 | Mark Lyman Magulac M.d., A Professional Corporation 11440 W Bernardo Ct Suite 300 San Diego CA 92127-1641 Ph: (858) 487-3330 |
| NPI Number | 1851713002 |
|---|---|
| Provider Enumeration Date | 01/07/2014 |
| Last Update Date | 01/07/2014 |
| Medicare PECOS PAC ID | 6406071166 |
|---|---|
| Medicare Enrollment ID | O20140714001289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851713002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G56157 (California) | Primary |
| Provider Name | Mark L Magulac |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427085661 PECOS PAC ID: 1254415797 Enrollment ID: I20080222000328 |
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