Provider Demographics
NPI:1780383422
Name:MIRELES, JAN FRANCIS
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:FRANCIS
Last Name:MIRELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9963 SW 26TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2655
Mailing Address - Country:US
Mailing Address - Phone:305-927-1071
Mailing Address - Fax:
Practice Address - Street 1:9963 SW 26TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2655
Practice Address - Country:US
Practice Address - Phone:305-927-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156361106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician