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General NPI Number Information
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NPI Number | 1558275669
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Entity Type | Individual
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Provider Name | MARIO MAGALLON
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Gender | Male
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 650 S INDIAN HILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-5444
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Country | US
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Telephone | 909-422-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 3865 LINDSAY ST
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City | RIVERSIDE
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State | CA
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Zip | 92509-2526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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