Provider Demographics
NPI:1164038360
Name:MAGADIA, PRINCESS
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:MAGADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 HURLEY WAY STE 290
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3221
Mailing Address - Country:US
Mailing Address - Phone:916-905-1699
Mailing Address - Fax:916-550-1124
Practice Address - Street 1:2035 HURLEY WAY STE 290
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3221
Practice Address - Country:US
Practice Address - Phone:916-905-1699
Practice Address - Fax:916-550-1124
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician