Provider Demographics
NPI:1306019724
Name:PRIETO, JOEL
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:PRIETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 KURT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6933
Mailing Address - Country:US
Mailing Address - Phone:818-943-7777
Mailing Address - Fax:818-686-6463
Practice Address - Street 1:10300 KURT ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW TERRACE
Practice Address - State:CA
Practice Address - Zip Code:91342-6933
Practice Address - Country:US
Practice Address - Phone:818-943-7777
Practice Address - Fax:818-686-6463
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)