Healthcare Provider Details

I. General information

NPI: 1639826506
Provider Name (Legal Business Name): EMILY MARIE MAGALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N WHITE RD
SAN JOSE CA
95127-1439
US

IV. Provider business mailing address

1922 THE ALAMEDA
SAN JOSE CA
95126-1457
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-0760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: