Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114209574 |
---|---|
Provider Name | Mr. Oscar Magdaleno |
First Address | Pacoima, CA 91331-1391 |
Second Address | Pacoima, CA 91331-1391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2011 |
Last Update Date | 13/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7068 | (05) | CA |
7420 | (05) | CA |