Basic Information
Provider Information
NPI: 1588394761
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: MAGDALENA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3330 LOMITA BLVD
Address2:  
City: TORRANCE
State: CA
PostalCode: 905055002
CountryCode: US
TelephoneNumber: 3103259110
FaxNumber:  
Practice Location
Address1: 3330 LOMITA BLVD
Address2:  
City: TORRANCE
State: CA
PostalCode: 905055002
CountryCode: US
TelephoneNumber: 3103259110
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2022
LastUpdateDate: 06/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WE0003X547651CAY Nursing Service ProvidersRegistered NurseEmergency

No ID Information.


Home