Provider Demographics
NPI:1437616984
Name:PRIETO, MICHAEL ANGEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANGEL
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 1:200 E WSHGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1806
Mailing Address - Country:US
Mailing Address - Phone:760-741-7708
Mailing Address - Fax:
Practice Address - Street 1:200 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1806
Practice Address - Country:US
Practice Address - Phone:760-741-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)