Provider Demographics
NPI:1619203205
Name:MAGALLANES-EVANS, JESSICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:MAGALLANES-EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1099
Mailing Address - Country:US
Mailing Address - Phone:831-459-2628
Mailing Address - Fax:831-459-5116
Practice Address - Street 1:1156 HIGH ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064-1099
Practice Address - Country:US
Practice Address - Phone:831-459-2628
Practice Address - Fax:831-459-5116
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical