Healthcare Provider Details

I. General information

NPI: 1467539007
Provider Name (Legal Business Name): ALZADA MAGDALENA L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 7TH ST
DAVIS CA
95616-3708
US

IV. Provider business mailing address

717 7TH ST
DAVIS CA
95616-3708
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-4521
  • Fax: 530-750-7909
Mailing address:
  • Phone: 530-756-4521
  • Fax: 530-750-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: