MEDICARE: JONATHAN E MAGDALENO RODRIGUEZ FNP-C

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	163W00000X	Registered Nurse	95171857	CA
2	363L00000X	Nurse Practitioner	95030904	CA
3	363LF0000X	Family Nurse Practitioner	95030904	CA

General Provider Information

NPI Number	:	1730904699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN E MAGDALENO RODRIGUEZ FNP-C

Provider Business Mailing Address
First Line	:	1150 N INDIAN CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4872
Country	:	US
Telephone Number	:	310-722-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:	562-435-3666
Fax Number	:

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

Provider Enumeration Date	:	11/16/2024
Last Update Date	:	03/05/2026

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