Provider Demographics
NPI:1861217390
Name:MAGBANUA, MADYSEN LINDA (MOT)
Entity type:Individual
Prefix:
First Name:MADYSEN
Middle Name:LINDA
Last Name:MAGBANUA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12832 TEXANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3618
Mailing Address - Country:US
Mailing Address - Phone:858-414-9031
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR STE 2006
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4925
Practice Address - Country:US
Practice Address - Phone:619-255-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist