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General NPI Number Information
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NPI Number | 1811786825
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Entity Type | Organization
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Legal Business Name | MAGNOLIA CONGREGATE LIVING INC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1572 EVERGREEN LN
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City | CORONA
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State | CA
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Zip | 92879-3010
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Country | US
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Telephone | 562-301-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 4042 WINTERHAVEN ST
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City | YORBA LINDA
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State | CA
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Zip | 92886-1647
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Country | US
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Telephone | 562-301-8792
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Fax |
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Authorized Official
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Title or Position | CNO
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Name | CINDY CORNEJO LE
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Credential | NP
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Telephone | 562-301-8792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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