Healthcare Provider Details

I. General information

NPI: 1730904699
Provider Name (Legal Business Name): JONATHAN E MAGDALENO RODRIGUEZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OCEANGATE
LONG BEACH CA
90802-4302
US

IV. Provider business mailing address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-3666
  • Fax:
Mailing address:
  • Phone: 310-722-5728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030904
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030904
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95171857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: