Healthcare Provider Details

I. General information

NPI: 1487580411
Provider Name (Legal Business Name): NICOLE MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5922 SMOKE TREE RD
PHELAN CA
92371-7420
US

IV. Provider business mailing address

5922 SMOKE TREE RD
PHELAN CA
92371-7420
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-6016
  • Fax:
Mailing address:
  • Phone: 323-798-6016
  • Fax: 323-798-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: