Provider Demographics
NPI:1710533849
Name:ARIZA-NIETO, MAGNOLIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAGNOLIA
Middle Name:
Last Name:ARIZA-NIETO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ASTER LN APT 215
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1372
Mailing Address - Country:US
Mailing Address - Phone:607-229-2780
Mailing Address - Fax:
Practice Address - Street 1:108 ASTER LN APT 215
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1372
Practice Address - Country:US
Practice Address - Phone:607-229-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171R00000XOther Service ProvidersInterpreter