Provider Demographics
NPI:1952033433
Name:MIA VELARDE
Entity Type:Organization
Organization Name:MIA VELARDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-238-8474
Mailing Address - Street 1:7020 TOLENTINO PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9003
Mailing Address - Country:US
Mailing Address - Phone:909-764-8830
Mailing Address - Fax:
Practice Address - Street 1:7020 TOLENTINO PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9003
Practice Address - Country:US
Practice Address - Phone:909-238-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty