Provider Demographics
NPI:1851752646
Name:CHIRINO FUENTES, MIRIAM GREICYS
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:GREICYS
Last Name:CHIRINO FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:GREICYS
Other - Last Name:CHIRINO FUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:894 LADY MARLENE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1363
Mailing Address - Country:US
Mailing Address - Phone:702-712-0229
Mailing Address - Fax:
Practice Address - Street 1:894 LADY MARLENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1363
Practice Address - Country:US
Practice Address - Phone:702-712-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst