Magnolia Diagnostic Center,Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MAGNOLIA DIAGNOSTIC CENTER,INC

Practice address

2100 N Dr Martin Luther King Jr Blvd
Clovis, NM 88101-9412

Phone

(509) 389-9765

Fax

(505) 213-0132

NPI assigned

Nov 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ramon Gutierrez

Title

President

Phone

(509) 389-9765

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710057740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N DR MARTIN LUTHER KING JR BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019412",
            "telephone_number": "509-389-9765",
            "fax_number": "505-213-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N DR MARTIN LUTHER KING JR BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019412",
            "telephone_number": "509-389-9765",
            "fax_number": "505-213-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DIAGNOSTIC CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "RAMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-389-9765"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Abelino Madrid, DDS
• Jennifer Cassie Maes, RN
• Kathie D Maestas, LMHC
• Mark A Maestas, YOUTHCARE SPECIALIST
• Pearl Angeline Tongol Maglaya
• Jessica Maldonado, SLP
• Oliver M Mancilla, BT
• Robert Allen Manson
• Luzmeilyn Mansur
• Manual Medicine Rehabilitation & Research, L.L.C.

• Clinical Medical Laboratory in Clovis, NM
• Providers in Clovis, NM by specialty
• Clinical Medical Laboratory in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.