Provider Demographics
NPI:1588854368
Name:MAGPAYO, EDUARDO MALAYAO (IDC)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:MALAYAO
Last Name:MAGPAYO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 IMPERIAL BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2845
Mailing Address - Country:US
Mailing Address - Phone:619-934-6458
Mailing Address - Fax:619-524-0852
Practice Address - Street 1:35000 GUADALCANAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5599
Practice Address - Country:US
Practice Address - Phone:619-524-8307
Practice Address - Fax:619-524-0852
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman