MEDICARE: MR. JAY JAY MAGTOTO JOSEPH APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	1304	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN00001304	OTHER	NV	APN LICENSE
2	CS19512	OTHER	NV	CONTROLLED SUBSTANCE NUMBER

General Provider Information

NPI Number	:	1336429745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY JAY MAGTOTO JOSEPH APN

Provider Business Mailing Address
First Line	:	1321 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9047
Country	:	US
Telephone Number	:	702-476-2287
Fax Number	:	702-476-2975

Provider Business Practice Location Address
First Line	:	1321 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9047
Country	:	US
Telephone Number	:	702-476-2287
Fax Number	:	702-476-2975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	03/07/2023

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