Provider Demographics
NPI:1629720883
Name:MAGNOLIA NURSING PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MAGNOLIA NURSING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:714-785-3639
Mailing Address - Street 1:8453 PENNY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1488
Mailing Address - Country:US
Mailing Address - Phone:714-785-3639
Mailing Address - Fax:
Practice Address - Street 1:3435 WILSHIRE BLVD STE 2780
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1901
Practice Address - Country:US
Practice Address - Phone:714-785-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty