Provider Demographics
NPI:1558826701
Name:CHILES, MISHAEL MONI
Entity Type:Individual
Prefix:
First Name:MISHAEL
Middle Name:MONI
Last Name:CHILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 W CRESCENT AVE STE 244
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3836
Mailing Address - Country:US
Mailing Address - Phone:714-829-4138
Mailing Address - Fax:
Practice Address - Street 1:2115 W CRESCENT AVE STE 244
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3836
Practice Address - Country:US
Practice Address - Phone:714-829-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician