Provider Demographics
NPI:1629737523
Name:ARCINIEGA, MIRIAM JANAY (ASW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JANAY
Last Name:ARCINIEGA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3368
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-3368
Mailing Address - Country:US
Mailing Address - Phone:818-287-1543
Mailing Address - Fax:
Practice Address - Street 1:16519 VICTOR ST STE 421
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3935
Practice Address - Country:US
Practice Address - Phone:442-242-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW103741390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty