Individual
LISA MAGDALENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
3451 E 12TH ST, OAKLAND, CA 94601-3463
(510) 535-3500
Mailing address
6486 FLAMINGO DR, BUENA PARK, CA 90620-1334
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95260463
CA
363LG0600X
Gerontology Nurse Practitioner
95026202
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
95026202
CA
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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