Provider Demographics
NPI:1215200241
Name:DESSAINT, MAYRA ALEJANDRA
Entity Type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:DESSAINT
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 1:12700 VAN NUYS BLVD APT 292
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1625
Mailing Address - Country:US
Mailing Address - Phone:818-913-1968
Mailing Address - Fax:
Practice Address - Street 1:12700 VAN NUYS BLVD APT 292
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1625
Practice Address - Country:US
Practice Address - Phone:818-913-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)