Provider Demographics
NPI:1164863205
Name:MAGALLAN, MONICA MUNOZ (MS)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MUNOZ
Last Name:MAGALLAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 S JONES BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1299
Mailing Address - Country:US
Mailing Address - Phone:702-824-1924
Mailing Address - Fax:
Practice Address - Street 1:2920 N GREEN VALLEY PKWY STE 311
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0412
Practice Address - Country:US
Practice Address - Phone:702-508-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVMI0904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner