Provider Demographics
NPI:1396180212
Name:KIRTS, SULMY MAYLY (MPA)
Entity Type:Individual
Prefix:
First Name:SULMY
Middle Name:MAYLY
Last Name:KIRTS
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:SULMY
Other - Middle Name:MAYLY
Other - Last Name:SALAZAR CIFUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10261 TRADEMARK ST STE C
Mailing Address - Street 2:
Mailing Address - City:RCH CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5805
Mailing Address - Country:US
Mailing Address - Phone:909-317-8499
Mailing Address - Fax:
Practice Address - Street 1:10261 TRADEMARK ST STE C
Practice Address - Street 2:
Practice Address - City:RCH CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5805
Practice Address - Country:US
Practice Address - Phone:909-317-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22540000XOtherNIP