Healthcare Provider Details

I. General information

NPI: 1598404360
Provider Name (Legal Business Name): DAICY C MAGALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E COOLEY DR UNIT 129
COLTON CA
92324-3934
US

IV. Provider business mailing address

PO BOX 941
TWIN PEAKS CA
92391-0941
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-2606
  • Fax:
Mailing address:
  • Phone: 909-206-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: