Healthcare Provider Details

I. General information

NPI: 1134891732
Provider Name (Legal Business Name): EVELYN MAGDALENO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CHANNEL ISLANDS BLVD
OXNARD CA
93033-4501
US

IV. Provider business mailing address

325 W CHANNEL ISLANDS BLVD
OXNARD CA
93033-4501
US

V. Phone/Fax

Practice location:
  • Phone: 805-240-7000
  • Fax:
Mailing address:
  • Phone: 805-240-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: