Provider Demographics
NPI:1235750209
Name:MAGANIS, JONATHAN CORRALES (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CORRALES
Last Name:MAGANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4910 S. AIRPORT PLAZA DR.
Practice Address - Street 2:OPTUM
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1376
Practice Address - Country:US
Practice Address - Phone:562-429-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAA187673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program