Provider Demographics
NPI:1316065279
Name:MAGDALENO, JUANITA
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:MAGDALENO
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MAGDALENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2772 SOUTH MARTIN LUTHER KING
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-0000
Mailing Address - Country:US
Mailing Address - Phone:559-265-4800
Mailing Address - Fax:559-265-4823
Practice Address - Street 1:2772 S. MARTIN LUTHER KING
Practice Address - Street 2:SAME AS ABOVE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-0000
Practice Address - Country:US
Practice Address - Phone:559-265-4800
Practice Address - Fax:559-265-4823
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)