Healthcare Provider Details

I. General information

NPI: 1154120988
Provider Name (Legal Business Name): MARIA-MAGDA CIOCAZAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737B CODY ST
BONNERS FERRY ID
83805-8504
US

IV. Provider business mailing address

PO BOX 1013
BONNERS FERRY ID
83805-1013
US

V. Phone/Fax

Practice location:
  • Phone: 208-907-1517
  • Fax: 208-267-9303
Mailing address:
  • Phone: 208-907-1517
  • Fax: 208-267-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASG-677
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: