Healthcare Provider Details

I. General information

NPI: 1033905476
Provider Name (Legal Business Name): MAGNOLIA HOPE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16958 SIERRA VISTA WAY
CERRITOS CA
90703-1844
US

IV. Provider business mailing address

16958 SIERRA VISTA WAY
CERRITOS CA
90703-1844
US

V. Phone/Fax

Practice location:
  • Phone: 562-780-6532
  • Fax:
Mailing address:
  • Phone: 562-774-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ROCIO MALLARI
Title or Position: CEO
Credential:
Phone: 562-774-5732