Healthcare Provider Details

I. General information

NPI: 1780593384
Provider Name (Legal Business Name): AL GENER MAGTAJAS RN, CNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W LA VETA AVE UNIT H1
ORANGE CA
92868-4420
US

IV. Provider business mailing address

700 W LA VETA AVE UNIT H1
ORANGE CA
92868-4420
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-4493
  • Fax:
Mailing address:
  • Phone: 951-224-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number781602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: