Provider Demographics
NPI:1467516203
Name:MAGALONG, MICHAEL VALLEJOS (MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VALLEJOS
Last Name:MAGALONG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5178 CARISBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3854
Mailing Address - Country:US
Mailing Address - Phone:707-399-4900
Mailing Address - Fax:
Practice Address - Street 1:5178 CARISBROOKE LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3854
Practice Address - Country:US
Practice Address - Phone:707-399-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 38021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist