Provider Demographics
NPI:1447422738
Name:OVIEDO, MIROSLAVA LAURA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MIROSLAVA
Middle Name:LAURA
Last Name:OVIEDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-2044
Mailing Address - Country:US
Mailing Address - Phone:520-202-1722
Mailing Address - Fax:520-202-1889
Practice Address - Street 1:160 W FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3812
Practice Address - Country:US
Practice Address - Phone:520-318-3266
Practice Address - Fax:520-318-0821
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11621101YA0400X
AZLMSW-113761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)