Provider Demographics
NPI:1043963465
Name:MAGANA MORILLON, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MAGANA MORILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W SHAW AVE STE D1
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3513
Mailing Address - Country:US
Mailing Address - Phone:559-978-4663
Mailing Address - Fax:
Practice Address - Street 1:1616 W SHAW AVE STE D1
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3513
Practice Address - Country:US
Practice Address - Phone:559-978-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist