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General NPI Number Information
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NPI Number | 1912815358
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Entity Type | Individual
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Provider Name | JONATHAN TYLER MADRIAGA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 200 MERCY CIR
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City | CAMP PENDLETON
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State | CA
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Zip | 92055
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Country | US
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Telephone | 760-725-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 118 MCCORMICK ST
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-2610
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Country | US
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Telephone | 310-995-5714
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 92832
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License Number State | CA
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