Healthcare Provider Details

I. General information

NPI: 1063390946
Provider Name (Legal Business Name): JAIME ZAMORA MAGANA AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 CONANT AVE
MODESTO CA
95350-1799
US

IV. Provider business mailing address

2410 JANNA AVE
MODESTO CA
95350-1910
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-5430
  • Fax:
Mailing address:
  • Phone: 209-529-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: