Provider Demographics
NPI:1972920429
Name:MAGAOAY, KALANI
Entity Type:Individual
Prefix:MR
First Name:KALANI
Middle Name:
Last Name: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 1:2191 DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-4774
Mailing Address - Country:US
Mailing Address - Phone:760-577-8994
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:SUITE 324
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-749-3200
Practice Address - Fax:702-749-3202
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst