MEDICARE: MARISOL MALAGON LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	274501	CA

General Provider Information

NPI Number	:	1225661747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL MALAGON LOPEZ

Provider Business Mailing Address
First Line	:	1448 W BERKELEY CT
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2010
Country	:	US
Telephone Number	:	626-376-8503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 W BERKELEY CT
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2010
Country	:	US
Telephone Number	:	626-376-8503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	07/29/2024

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