Provider Demographics
NPI:1770861437
Name:MAGALLANES, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MAGALLANES
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 1:3400 CENTRAL AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2176
Mailing Address - Country:US
Mailing Address - Phone:626-222-6965
Mailing Address - Fax:951-346-9583
Practice Address - Street 1:3400 CENTRAL AVE STE 215
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2176
Practice Address - Country:US
Practice Address - Phone:951-934-8944
Practice Address - Fax:951-346-9583
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist