Provider Demographics
NPI:1598468308
Name:MAGDAEL, CECILIA (LVN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MAGDAEL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:TAGALA
Other - Last Name:MAGDAEL-IVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1440 BEAUMONT AVEUE
Mailing Address - Street 2:SUITE A2 #221
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223
Mailing Address - Country:US
Mailing Address - Phone:760-409-4752
Mailing Address - Fax:
Practice Address - Street 1:800 E LUGONIA AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2550
Practice Address - Country:US
Practice Address - Phone:909-307-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN144461164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse