Provider Demographics
NPI:1275029142
Name:MIRELES, PRISCILLA ANN (BT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:MIRELES
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VERA CRUZ CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4069
Mailing Address - Country:US
Mailing Address - Phone:831-776-3774
Mailing Address - Fax:
Practice Address - Street 1:9010 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4082
Practice Address - Country:US
Practice Address - Phone:831-684-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician