Provider Demographics
NPI:1306389051
Name:MIRAMONTES, MARIA D (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:MIRAMONTES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DE LOS ANGELES
Other - Last Name:MIRAMONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1635 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4325
Mailing Address - Country:US
Mailing Address - Phone:909-670-7511
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE B208
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4912
Practice Address - Country:US
Practice Address - Phone:909-476-6464
Practice Address - Fax:909-476-6868
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT 15-11299OtherBACB