Provider Demographics
NPI:1053845487
Name:ATTEYA, MIRETTE
Entity Type:Individual
Prefix:
First Name:MIRETTE
Middle Name:
Last Name:ATTEYA
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 1:3077 N JUNEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5001
Mailing Address - Country:US
Mailing Address - Phone:714-749-5786
Mailing Address - Fax:
Practice Address - Street 1:72314 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2747
Practice Address - Country:US
Practice Address - Phone:760-469-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist