Provider Demographics
NPI:1669201729
Name:BRITO, MIA DESTINY
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:DESTINY
Last Name:BRITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:DESTINY
Other - Last Name:BRITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12702 ARISTOCRAT AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4634
Mailing Address - Country:US
Mailing Address - Phone:714-499-6368
Mailing Address - Fax:
Practice Address - Street 1:5252 ORANGE AVE STE 109
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2967
Practice Address - Country:US
Practice Address - Phone:657-214-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician