Healthcare Provider Details

I. General information

NPI: 1861313215
Provider Name (Legal Business Name): ELIZEL KEN MAGLIBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 SAN MARINO AVE
CLOVIS CA
93619-7952
US

IV. Provider business mailing address

1724 SAN MARINO AVE
CLOVIS CA
93619-7952
US

V. Phone/Fax

Practice location:
  • Phone: 818-530-3725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95257115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: