Provider Demographics
NPI:1982010195
Name:MAGDALENO, RAFAEL
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MAGDALENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0235
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5410
Practice Address - Street 1:2355 CRENSHAW BLVD STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3329
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-698-5410
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist