Provider Demographics
NPI:1144729559
Name:MAGDALENO, MARISSA DELORES
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:DELORES
Last Name:MAGDALENO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:DELORES
Other - Last Name:CANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST
Mailing Address - Street 2:STE. 1800
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:
Practice Address - Street 1:8951 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3984
Practice Address - Country:US
Practice Address - Phone:805-703-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician