Provider Demographics
NPI:1316925530
Name:MAGALLON, RICHARD JACKSON (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JACKSON
Last Name:MAGALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1334 W COVINA BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3211
Mailing Address - Country:US
Mailing Address - Phone:626-963-1645
Mailing Address - Fax:909-394-0841
Practice Address - Street 1:1334 W COVINA BLVD
Practice Address - Street 2:STE 206
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:626-963-1645
Practice Address - Fax:909-394-0841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA21166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine