Provider Demographics
NPI:1447595921
Name:MAGPUSAO, MEGAN MIGALLOS (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MIGALLOS
Last Name:MAGPUSAO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27550 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4716
Mailing Address - Country:US
Mailing Address - Phone:510-314-9737
Mailing Address - Fax:
Practice Address - Street 1:385 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1882
Practice Address - Country:US
Practice Address - Phone:650-993-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA811536163W00000X
OH380256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse