Provider Demographics
NPI:1972049062
Name:MIRELES, JOSEPH ROMERO (BA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROMERO
Last Name:MIRELES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5938 1/2 CAMELLIA AVE.
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780
Mailing Address - Country:US
Mailing Address - Phone:310-488-3432
Mailing Address - Fax:
Practice Address - Street 1:5938 1/2 CAMELLIA AVE.
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780
Practice Address - Country:US
Practice Address - Phone:310-488-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician