Healthcare Provider Details

I. General information

NPI: 1982434734
Provider Name (Legal Business Name): RAMESES MAGTANONG MSN, RN, CNOR, CSSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 N ACADEMY BLVD STE 290
COLORADO SPRINGS CO
80918-4038
US

IV. Provider business mailing address

3015 BELLA CIMA DR
COLORADO SPRINGS CO
80918-4654
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-2061
  • Fax: 719-434-2275
Mailing address:
  • Phone: 203-570-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.1623823
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN.1623823
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1623823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: