Provider Demographics
NPI:1275974495
Name:MIRELES, LETICIA (MS)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MIRELES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:ESPINOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:13585 SAN PABLO AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3863
Mailing Address - Country:US
Mailing Address - Phone:510-942-4600
Mailing Address - Fax:510-942-4601
Practice Address - Street 1:13585 SAN PABLO AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3863
Practice Address - Country:US
Practice Address - Phone:510-942-4600
Practice Address - Fax:510-942-4601
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82764106H00000X, 390200000X
CA121198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program