Healthcare Provider Details

I. General information

NPI: 1245168020
Provider Name (Legal Business Name): MAGALY JAIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALNUT AVE
SANTA CRUZ CA
95060-3900
US

IV. Provider business mailing address

135 LANDIS AVE APT 135-K
FREEDOM CA
95019-3034
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: