Provider Demographics
NPI:1356564611
Name:REZENDES, MIA F
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:F
Last Name:REZENDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8278 GILMAN DR
Mailing Address - Street 2:#35
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2636
Mailing Address - Country:US
Mailing Address - Phone:858-539-1710
Mailing Address - Fax:
Practice Address - Street 1:1840 WILSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5515
Practice Address - Country:US
Practice Address - Phone:619-477-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker