Provider Demographics
NPI:1245113901
Name:MAGNELIA HEALTHCARE CORP
Entity type:Organization
Organization Name:MAGNELIA HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGNELIA
Authorized Official - Middle Name:NICOLASA
Authorized Official - Last Name:VAZQUEZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-857-2379
Mailing Address - Street 1:9565 SW 24TH ST APT H112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8024
Mailing Address - Country:US
Mailing Address - Phone:786-857-2379
Mailing Address - Fax:
Practice Address - Street 1:9565 SW 24TH ST APT H112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8024
Practice Address - Country:US
Practice Address - Phone:786-857-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty