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General NPI Number Information
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NPI Number | 1730904699
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Entity Type | Individual
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Provider Name | JONATHAN E MAGDALENO RODRIGUEZ FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/16/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 200 OCEANGATE
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City | LONG BEACH
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State | CA
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Zip | 90802-4302
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Country | US
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Telephone | 562-435-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 1238 DAISY DR
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City | BEAUMONT
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State | CA
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Zip | 92223-8408
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Country | US
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Telephone | 310-722-5728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95171857
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95030904
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License Number State | CA
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