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General NPI Number Information
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NPI Number | 1649734724
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Entity Type | Individual
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Provider Name | IMELDA MOYA-MAGANA LPCC 18053
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 2125 CITRACADO PKWY STE 200
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City | ESCONDIDO
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State | CA
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Zip | 92029-4159
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Country | US
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Telephone | 760-294-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 VIA SALERNO
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City | ESCONDIDO
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State | CA
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Zip | 92026-2252
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Country | US
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Telephone | 661-305-4596
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18053
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License Number State | CA
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