MEDICARE: SIRENA LISETTE MAGALLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	1611	CA
2	235Z00000X	Speech-Language Pathologist	26713	CA

General Provider Information

NPI Number	:	1194067405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRENA LISETTE MAGALLON

Provider Business Mailing Address
First Line	:	14772 PIPELINE AVE STE A
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6027
Country	:	US
Telephone Number	:	909-606-0886
Fax Number	:

Provider Business Practice Location Address
First Line	:	14772 PIPELINE AVE STE A
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6027
Country	:	US
Telephone Number	:	909-606-0886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	02/23/2019

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Directions to “ SIRENA LISETTE MAGALLON ” Practice Location

Language	Start Address	Practice Location

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