Provider Demographics
NPI:1992773279
Name:MAGALONG, ELPIDIO POSA JR (MD)
Entity type:Individual
Prefix:DR
First Name:ELPIDIO
Middle Name:POSA
Last Name:MAGALONG
Suffix:JR
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 1:1050 MARINA VILLAGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1033
Mailing Address - Country:US
Mailing Address - Phone:510-227-5540
Mailing Address - Fax:510-788-6849
Practice Address - Street 1:1050 MARINA VILLAGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1033
Practice Address - Country:US
Practice Address - Phone:510-227-5540
Practice Address - Fax:510-788-6849
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A790081Medicaid
H71075Medicare UPIN
00A790081Medicare ID - Type Unspecified