Provider Demographics
NPI:1730904699
Name:MAGDALENO RODRIGUEZ, JONATHAN E (FNP-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:MAGDALENO RODRIGUEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 DAISY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8408
Mailing Address - Country:US
Mailing Address - Phone:310-722-5728
Mailing Address - Fax:
Practice Address - Street 1:200 OCEANGATE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4302
Practice Address - Country:US
Practice Address - Phone:562-435-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171857163W00000X
CA95030904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse