Provider Demographics
NPI:1396250676
Name:MAGTIBAY, RHODORA DE LA PENA (NP/ AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:RHODORA
Middle Name:DE LA PENA
Last Name:MAGTIBAY
Suffix:
Gender:F
Credentials:NP/ AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 MERCY CT STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3171
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:
Practice Address - Street 1:6608 MERCY CT STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3171
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839678163W00000X
CANP95007614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse