Provider Demographics
NPI:1386450963
Name:MALAGON, GIZI MERASI (ADAPT PE SPECIALIST)
Entity type:Individual
Prefix:
First Name:GIZI
Middle Name:MERASI
Last Name:MALAGON
Suffix:
Gender:F
Credentials:ADAPT PE SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 183RD ST # 1055
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5434
Mailing Address - Country:US
Mailing Address - Phone:323-979-6118
Mailing Address - Fax:
Practice Address - Street 1:11331 183RD ST # 1055
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5434
Practice Address - Country:US
Practice Address - Phone:323-979-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240014603174H00000X
CA240032235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator