Healthcare Provider Details

I. General information

NPI: 1255250767
Provider Name (Legal Business Name): MONIQUE ADAMARIS MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 S 1050 E
SOUTH OGDEN UT
84405-7078
US

IV. Provider business mailing address

454 S 150 W
OGDEN UT
84404-7333
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-8455
  • Fax:
Mailing address:
  • Phone: 801-600-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14295612-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: