Provider Demographics
NPI:1043345945
Name:MAGALLANES, SYLVIA DOLORES (CNM, RNP, MS)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:DOLORES
Last Name:MAGALLANES
Suffix:
Gender:F
Credentials:CNM, RNP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7965 SIERRA AVE
Mailing Address - Street 2:STE E
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3329
Mailing Address - Country:US
Mailing Address - Phone:909-356-4459
Mailing Address - Fax:909-935-5426
Practice Address - Street 1:7965 SIERRA AVE
Practice Address - Street 2:STE E
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3329
Practice Address - Country:US
Practice Address - Phone:909-356-4459
Practice Address - Fax:909-355-4261
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301165363LX0001X
CA868367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 17858OtherBRN
CANMF 868OtherBRN
CANMW 868OtherBRN
CARN 301165OtherBRN
CARN 301165OtherBRN