Provider Demographics
NPI:1427284405
Name:MAGALLON, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MAGALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13252 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2204
Mailing Address - Country:US
Mailing Address - Phone:714-740-1778
Mailing Address - Fax:714-740-1913
Practice Address - Street 1:13252 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2204
Practice Address - Country:US
Practice Address - Phone:714-740-1778
Practice Address - Fax:714-740-1913
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28454208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice