Healthcare Provider Details

I. General information

NPI: 1497618599
Provider Name (Legal Business Name): FNU GEETA MAGESH MPHIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEETA MAGESH MPHIL

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ALVARADO AVE APT 125
DAVIS CA
95616-0679
US

IV. Provider business mailing address

880 ALVARADO AVE APT 125
DAVIS CA
95616-0679
US

V. Phone/Fax

Practice location:
  • Phone: 530-574-4668
  • Fax:
Mailing address:
  • Phone: 530-574-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: