Active NPI
Marly Mackles
- Certified Registered Nurse Anesthetist
- Phelan, CA
National Provider Identifier
1811893191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 95002990
- Practice address
- 4730 Amador Rd
Phelan, CA 92371-7000 - Phone
- (760) 810-2187
- NPI assigned
- Oct 15, 2026
- Last updated
- Oct 15, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 95002990 | CA | Primary |
Addresses
Primary practice location
4730 Amador Rd
Phelan, CA 92371-7000
Mailing address
4730 Amador Rd
Phelan, CA 92371-7000
Other names 1
- Marly Gallegos Vargas
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1792022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1792022400000",
"number": "1811893191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4730 AMADOR RD",
"city": "PHELAN",
"state": "CA",
"postal_code": "923717000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 AMADOR RD",
"city": "PHELAN",
"state": "CA",
"postal_code": "923717000",
"telephone_number": "760-810-2187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKLES",
"first_name": "MARLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-10-15",
"last_updated": "2026-10-15",
"certification_date": "2026-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "CA",
"license": "95002990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARLY",
"last_name": "GALLEGOS VARGAS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Phelan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.