Healthcare Provider Details

I. General information

NPI: 1699510545
Provider Name (Legal Business Name): ERIC JOSEPH MAGPANTAY SIBAL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 OAK PARK BLVD
PLEASANT HILL CA
94523-4601
US

IV. Provider business mailing address

144 S CATALINA AVE APT 12
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-6630
  • Fax:
Mailing address:
  • Phone: 929-615-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number309816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: