Provider Demographics
NPI:1639903719
Name:IRLANDA, MARIANA AYLEEN
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:AYLEEN
Last Name:IRLANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:AYLEN
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 COPPER DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-5072
Mailing Address - Country:US
Mailing Address - Phone:760-362-9022
Mailing Address - Fax:
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY STE 110
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0113
Practice Address - Country:US
Practice Address - Phone:951-440-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst