Mark Lyman Magulac M.D., a Professional Corporation

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G56157 Issued in CA

Legal business name

MARK LYMAN MAGULAC M.D., A PROFESSIONAL CORPORATION

Practice address

11440 W Bernardo CT
Suite 300
San Diego, CA 92127-1641

Phone

(858) 487-3330

Fax

(858) 487-3331

NPI assigned

Jan 7, 2014

Organization subpart

No

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

Authorized official

Name

Mark Magulac, M.D.NPI 1427085661

Title

Owner

Phone

(858) 487-3330

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Lyman Magulac, MD

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1427085661
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1851713002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511267",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900517822",
            "telephone_number": "866-284-2771",
            "fax_number": "800-334-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11440 W BERNARDO CT",
            "address_2": "SUITE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921271641",
            "telephone_number": "858-487-3330",
            "fax_number": "858-487-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK LYMAN MAGULAC M.D., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "MAGULAC",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-487-3330",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G56157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.