Healthcare Provider Details

I. General information

NPI: 1639540685
Provider Name (Legal Business Name): TIFFANY MAGALLANES MS, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY STODDARD MS CPNP

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SANTA MARIA WAY
SANTA MARIA CA
93455-2118
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-5400
  • Fax: 805-938-9207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95004127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0991941
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: