Healthcare Provider Details

I. General information

NPI: 1396319497
Provider Name (Legal Business Name): EVELYN VIANNEY MAGANA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10227 PINNACLE RIDGE AVE
BAKERSFIELD CA
93311-3070
US

IV. Provider business mailing address

5558 CALIFORNIA AVE STE 340
BAKERSFIELD CA
93309-0710
US

V. Phone/Fax

Practice location:
  • Phone: 661-330-0726
  • Fax:
Mailing address:
  • Phone: 661-326-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: