Provider Demographics
NPI:1780317362
Name:MAGANA, JESSE (CMT)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:MAGANA
Suffix:
Gender:M
Credentials:CMT
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 6607
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-0607
Mailing Address - Country:US
Mailing Address - Phone:209-808-2581
Mailing Address - Fax:209-951-0448
Practice Address - Street 1:8807 THORNTON RD STE P
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1863
Practice Address - Country:US
Practice Address - Phone:209-808-2581
Practice Address - Fax:209-951-0448
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55139175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath