Provider Demographics
NPI:1659698421
Name:GIRON, MAYRA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEXANDRA
Last Name:GIRON
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 1:17701 AVALON BLVD
Mailing Address - Street 2:#300
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1554
Mailing Address - Country:US
Mailing Address - Phone:310-710-8083
Mailing Address - Fax:
Practice Address - Street 1:17701 AVALON BLVD
Practice Address - Street 2:#300
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1554
Practice Address - Country:US
Practice Address - Phone:310-710-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)