Provider Demographics
NPI:1336429745
Name:JOSEPH, JAY JAY MAGTOTO (APN)
Entity Type:Individual
Prefix:MR
First Name:JAY JAY
Middle Name:MAGTOTO
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:JAY MAGTOTO
Other - Last Name:LIWANAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 S RAINBOW BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9047
Mailing Address - Country:US
Mailing Address - Phone:702-476-2287
Mailing Address - Fax:702-476-2975
Practice Address - Street 1:1321 S RAINBOW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9047
Practice Address - Country:US
Practice Address - Phone:702-476-2287
Practice Address - Fax:702-476-2975
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1304363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPN00001304OtherAPN LICENSE
NVCS19512OtherCONTROLLED SUBSTANCE NUMBER
NVMJ2422917OtherDEA NUMBER