Provider Demographics
NPI:1346041878
Name:MAGAN, SOFIA G
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:G
Last Name:MAGAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10745 48TH AVE UNIT M1
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9186
Mailing Address - Country:US
Mailing Address - Phone:708-265-4530
Mailing Address - Fax:
Practice Address - Street 1:4830 BECKER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8616
Practice Address - Country:US
Practice Address - Phone:708-265-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician