Healthcare Provider Details

I. General information

NPI: 1093103905
Provider Name (Legal Business Name): MAGALY GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 HOLLYWOOD BLVD STE 815
LOS ANGELES CA
90028-6935
US

IV. Provider business mailing address

PO BOX 82322
BAKERSFIELD CA
93380-2322
US

V. Phone/Fax

Practice location:
  • Phone: 707-435-3799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: