Provider Demographics
NPI:1982225678
Name:MAGALLANES, TAYLOR LYLE
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:LYLE
Last Name:MAGALLANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 5TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2773
Mailing Address - Country:US
Mailing Address - Phone:805-245-8450
Mailing Address - Fax:
Practice Address - Street 1:901 E ALOSTA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2701
Practice Address - Country:US
Practice Address - Phone:626-815-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer