Healthcare Provider Details

I. General information

NPI: 1770246779
Provider Name (Legal Business Name): MAGNOLIA ACCESS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 2ND ST FL 8
LOS ANGELES CA
90012-4295
US

IV. Provider business mailing address

8453 PENNY DR
RIVERSIDE CA
92503-1488
US

V. Phone/Fax

Practice location:
  • Phone: 714-785-3639
  • Fax:
Mailing address:
  • Phone: 714-785-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN REYES
Title or Position: PRESIDENT
Credential: FNP
Phone: 714-785-3639