Provider Demographics
NPI:1033905476
Name:MAGNOLIA SUPPORT CENTER LLC
Entity type:Organization
Organization Name:MAGNOLIA SUPPORT CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-774-5732
Mailing Address - Street 1:16958 SIERRA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13055 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4930
Practice Address - Country:US
Practice Address - Phone:562-774-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty