Provider Demographics
NPI:1003882861
Name:ATTIAS-MAGANA, MIRIAM O (F-AAA)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:O
Last Name:ATTIAS-MAGANA
Suffix:
Gender:F
Credentials:F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15596 DWELLERS WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:952-715-7033
Mailing Address - Fax:866-213-4159
Practice Address - Street 1:1645 LYNDALE AVE N
Practice Address - Street 2:103
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2934
Practice Address - Country:US
Practice Address - Phone:507-412-0855
Practice Address - Fax:866-213-4159
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6170231H00000X
MN2338237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist