Provider Demographics
NPI:1356843205
Name:SALLES, MAGDA E (TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:E
Last Name:SALLES
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15969 NW 64TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5574
Mailing Address - Country:US
Mailing Address - Phone:786-417-7189
Mailing Address - Fax:
Practice Address - Street 1:15969 NW 64TH AVE APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5574
Practice Address - Country:US
Practice Address - Phone:786-417-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician