Provider Demographics
NPI:1902243827
Name:MAGOBET, VICKY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:MAGOBET
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 DIAMOND OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1755
Mailing Address - Country:US
Mailing Address - Phone:916-633-8353
Mailing Address - Fax:
Practice Address - Street 1:8624 DIAMOND OAK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1755
Practice Address - Country:US
Practice Address - Phone:916-633-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23027363LP0808X
CA84092163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse