=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710211321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XOCHITL MAGALLAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2009
-----------------------------------------------------
Last Update Date | 09/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 E HACKETT RD
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95358-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-558-3465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1416
-----------------------------------------------------
City | ATWATER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95301-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-357-8847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------