Healthcare Provider Details

I. General information

NPI: 1386334530
Provider Name (Legal Business Name): RAUL MAGALLON HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S STE 200A
HALF MOON BAY CA
94019-7210
US

IV. Provider business mailing address

225 CABRILLO HWY S STE 200A
HALF MOON BAY CA
94019-7210
US

V. Phone/Fax

Practice location:
  • Phone: 650-834-6523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT150310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: