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:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:LOS OLIVOS
Mailing Address - State:CA
Mailing Address - Zip Code:93441-0573
Mailing Address - Country:US
Mailing Address - Phone:805-245-8450
Mailing Address - Fax:
Practice Address - Street 1:2975 CA-246
Practice Address - Street 2:
Practice Address - City:SANTA YNEZ
Practice Address - State:CA
Practice Address - Zip Code:93460-2701
Practice Address - Country:US
Practice Address - Phone:805-688-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program