Provider Demographics
NPI:1427178367
Name:HAGA, MAGGIE TAM
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:TAM
Last Name:HAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:L
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19314 ALCONA ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3907
Mailing Address - Country:US
Mailing Address - Phone:626-893-8632
Mailing Address - Fax:
Practice Address - Street 1:7872 WALKER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1796
Practice Address - Country:US
Practice Address - Phone:626-893-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS174741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical