Healthcare Provider Details

I. General information

NPI: 1508546250
Provider Name (Legal Business Name): HADA-GUADALUPE MAGANA MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD
MODESTO CA
95355-3361
US

IV. Provider business mailing address

3301 37TH AVE
SACRAMENTO CA
95824-2418
US

V. Phone/Fax

Practice location:
  • Phone: 855-581-0100
  • Fax:
Mailing address:
  • Phone: 916-210-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: