Provider Demographics
NPI:1164259925
Name:MAGPAYO, RUBILHYN AMPON SANTOS
Entity type:Individual
Prefix:
First Name:RUBILHYN
Middle Name:AMPON SANTOS
Last Name:MAGPAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18410 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8626
Mailing Address - Country:US
Mailing Address - Phone:707-227-4593
Mailing Address - Fax:
Practice Address - Street 1:14440 OLYMPIC DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8809
Practice Address - Country:US
Practice Address - Phone:707-533-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH26317124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist