Healthcare Provider Details

I. General information

NPI: 1396236881
Provider Name (Legal Business Name): MARICEL DELIA MAGPAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 06/27/2018
Reactivation Date: 09/06/2018

III. Provider practice location address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

IV. Provider business mailing address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

V. Phone/Fax

Practice location:
  • Phone: 925-551-6905
  • Fax:
Mailing address:
  • Phone: 925-551-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT147388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: