Provider Demographics
NPI:1184208308
Name:ARIAS, MYRA JEANNETTE
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:JEANNETTE
Last Name:ARIAS
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 1:43979 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4635
Mailing Address - Country:US
Mailing Address - Phone:661-522-3711
Mailing Address - Fax:661-522-3714
Practice Address - Street 1:43979 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4635
Practice Address - Country:US
Practice Address - Phone:661-522-3711
Practice Address - Fax:661-522-3714
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07721524261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy