Provider Demographics
NPI:1346460847
Name:MAGALLANES, MARLOWE BISQUERRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLOWE
Middle Name:BISQUERRA
Last Name:MAGALLANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MONTEREY HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6119
Mailing Address - Country:US
Mailing Address - Phone:408-477-8080
Mailing Address - Fax:408-477-8081
Practice Address - Street 1:1901 MONTEREY HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6119
Practice Address - Country:US
Practice Address - Phone:408-477-8080
Practice Address - Fax:408-477-8081
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141398Medicare PIN