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General NPI Number Information
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NPI Number | 1245692268
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Entity Type | Organization
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Legal Business Name | MYLO MAGTOTO
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1080 CAROL LN SUITE 100
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City | LAFAYETTE
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State | CA
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Zip | 94549-4756
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Country | US
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Telephone | 510-459-9434
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 CAROL LN SUITE 100
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City | LAFAYETTE
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State | CA
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Zip | 94549-4756
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Country | US
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Telephone | 510-459-9434
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MYLO MAGTOTO
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Credential | DC
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Telephone | 510-459-9434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC28260
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License Number State | CA
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