Provider Demographics
NPI:1720802168
Name:MAGDALENO, PORTIA ISABELLA
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:ISABELLA
Last Name:MAGDALENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 E 19TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2840
Mailing Address - Country:US
Mailing Address - Phone:925-405-2559
Mailing Address - Fax:
Practice Address - Street 1:354 E 19TH ST # 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2840
Practice Address - Country:US
Practice Address - Phone:925-405-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program