=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043345945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYLVIA DOLORES MAGALLANES CNM, RNP, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7965 SIERRA AVE STE E
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-356-4459
-----------------------------------------------------
Fax | 909-355-4261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7965 SIERRA AVE STE E
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-356-4459
-----------------------------------------------------
Fax | 909-935-5426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | 301165
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 868
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------