Healthcare Provider Details

I. General information

NPI: 1285434514
Provider Name (Legal Business Name): JENNIFER L MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 RIDDER PARK DR
SAN JOSE CA
95131-2313
US

IV. Provider business mailing address

276 PALM VALLEY BLVD APT 111
SAN JOSE CA
95123-1049
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-9163
  • Fax:
Mailing address:
  • Phone: 408-658-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: