Provider Demographics
NPI:1710211321
Name:MAGALLAN, XOCHITL
Entity Type:Individual
Prefix:
First Name:XOCHITL
Middle Name:
Last Name:MAGALLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1416
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-1416
Mailing Address - Country:US
Mailing Address - Phone:209-357-8847
Mailing Address - Fax:
Practice Address - Street 1:251 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9800
Practice Address - Country:US
Practice Address - Phone:209-558-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional