Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 41643 | CA |
NPI | 1033327812 |
---|---|
Provider Name | Dr. Alexander Joseph Magallanes |
First Address | Redlands, CA 92373-7320 |
Second Address | Perris, CA 92570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 19/03/2014 |