# MAGNOLIA MEDICAL AESTHETICS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pueblo Primary Care Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851198444
- **Authorized official:** RONDA ORNDOFF DNP (OWNER/PROVIDER)
- **Authorized official phone:** (719) 250-9412

## Contact information

- **Practice address:** 415 N GRAND AVE, PUEBLO, CO 81003-3111
- **Practice address phone:** (719) 250-9412
- **Mailing address:** 1478 43RD LN, PUEBLO, CO 81006-9307
- **Mailing address phone:** (719) 250-9412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/28/2025
- **Last updated:** 06/12/2025