Provider Demographics
NPI:1295951044
Name:MAGAZ, NAZARE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NAZARE
Middle Name:
Last Name:MAGAZ
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 1:804 BRADISH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4666
Mailing Address - Country:US
Mailing Address - Phone:626-963-7070
Mailing Address - Fax:
Practice Address - Street 1:804 BRADISH AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4666
Practice Address - Country:US
Practice Address - Phone:626-963-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical