Provider Demographics
NPI:1629576566
Name:DELGADO ANDREZ, MIRNA (BCBA)
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:DELGADO ANDREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8350 ARCHIBALD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3670
Mailing Address - Country:US
Mailing Address - Phone:858-264-5858
Mailing Address - Fax:858-649-6012
Practice Address - Street 1:8350 ARCHIBALD AVE STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3670
Practice Address - Country:US
Practice Address - Phone:858-264-5858
Practice Address - Fax:858-649-6012
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-35649103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst