Provider Demographics
NPI:1447688007
Name:MAGNO, RAQUEL TOLENTINO (NP)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:TOLENTINO
Last Name:MAGNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:T
Other - Last Name:MAGNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:28308 SUMMERTRAIL PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6065
Mailing Address - Country:US
Mailing Address - Phone:909-864-2839
Mailing Address - Fax:
Practice Address - Street 1:28308 SUMMERTRAIL PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6065
Practice Address - Country:US
Practice Address - Phone:909-864-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669969538Other16699695538