Provider Demographics
NPI:1972819829
Name:MIRAMONTES, DAVID JUDE SR (CAARR CERTIFIED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JUDE
Last Name:MIRAMONTES
Suffix:SR
Gender:M
Credentials:CAARR CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2180 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4513
Mailing Address - Country:US
Mailing Address - Phone:805-781-4275
Mailing Address - Fax:805-781-1227
Practice Address - Street 1:3556 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2532
Practice Address - Country:US
Practice Address - Phone:805-461-6080
Practice Address - Fax:805-461-6114
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-066661 CAARR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)