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: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 W PRAIRIE AVE
HAYDEN ID
83835-8459
US

IV. Provider business mailing address

PO BOX 1013
BONNERS FERRY ID
83805-1013
US

V. Phone/Fax

Practice location:
  • Phone: 208-660-9378
  • Fax: 208-758-8527
Mailing address:
  • Phone: 208-304-7285
  • Fax: 208-758-8527

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: