Provider Demographics
NPI:1336900109
Name:MAGALLAN, JESSICA CRISTINA (SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CRISTINA
Last Name:MAGALLAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4017
Mailing Address - Country:US
Mailing Address - Phone:323-482-4349
Mailing Address - Fax:
Practice Address - Street 1:7373 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0500
Practice Address - Country:US
Practice Address - Phone:323-482-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist