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General NPI Number Information
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NPI Number | 1992459358
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Entity Type | Individual
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Provider Name | MR. RAYMOND URDANETA MAGPILE JR.
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Gender | Male
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 424 PENINSULA AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-1653
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Country | US
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Telephone | 650-286-4396
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Fax |
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Provider Business Mailing Address
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Address Line | 29 DOCKSIDE DR
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City | DALY CITY
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State | CA
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Zip | 94014-2815
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Country | US
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Telephone | 650-271-3533
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | CA
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