MEDICARE: JUAN ANGEL JASSO MAGDALENO M.D.

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	2080N0001X	Neonatal-Perinatal Medicine Physician	K2502	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457319410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN ANGEL JASSO MAGDALENO M.D.

Provider Business Mailing Address
First Line	:	1900 N OREGON ST
Second Line	:	601
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-542-0755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N OREGON ST
Second Line	:	601
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-542-0755
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	09/09/2011

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