Healthcare Provider Details

I. General information

NPI: 1447595921
Provider Name (Legal Business Name): MEGAN MIGALLOS MAGPUSAO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 ESPLANADE AVE
PACIFICA CA
94044-1882
US

IV. Provider business mailing address

27550 MIAMI AVE
HAYWARD CA
94545-4716
US

V. Phone/Fax

Practice location:
  • Phone: 650-993-5576
  • Fax:
Mailing address:
  • Phone: 510-314-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number811536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number380256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: