Healthcare Provider Details

I. General information

NPI: 1912815358
Provider Name (Legal Business Name): JONATHAN TYLER MADRIAGA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

118 MCCORMICK ST
SAN CLEMENTE CA
92672-2610
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone: 310-995-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: