Provider Demographics
NPI:1598255606
Name:MANIBUSAN-MAGAOAY, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MANIBUSAN-MAGAOAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MACE BLVD STE J PMB 114
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6077
Mailing Address - Country:US
Mailing Address - Phone:530-574-0556
Mailing Address - Fax:530-231-5723
Practice Address - Street 1:417 MACE BLVD. STE J PMB 114
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6077
Practice Address - Country:US
Practice Address - Phone:530-574-0556
Practice Address - Fax:530-231-5723
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst