Provider Demographics
NPI:1073189437
Name:MAGANA, JESUS (CADCII)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MAGANA
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31528 WHITECROWN DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3291
Mailing Address - Country:US
Mailing Address - Phone:949-842-6007
Mailing Address - Fax:
Practice Address - Street 1:2215 MESA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3707
Practice Address - Country:US
Practice Address - Phone:949-872-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA09960315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)