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General NPI Number Information
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NPI Number | 1255250767
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Entity Type | Individual
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Provider Name | MONIQUE ADAMARIS MAGANA
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Gender | Female
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 5540 S 1050 E
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-7078
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Country | US
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Telephone | 801-479-8455
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Fax |
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Provider Business Mailing Address
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Address Line | 454 S 150 W
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City | OGDEN
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State | UT
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Zip | 84404-7333
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Country | US
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Telephone | 801-600-3872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 14295612-4003
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License Number State | UT
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