Healthcare Provider Details

I. General information

NPI: 1376028068
Provider Name (Legal Business Name): JAZZELLE MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 KAUSEN DR STE 104
ELK GROVE CA
95758-7178
US

IV. Provider business mailing address

501 SHATTO PL STE 100
LOS ANGELES CA
90020-1747
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89113
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: