Provider Demographics
NPI:1780463992
Name:MILES, ALDEA POISSON
Entity type:Individual
Prefix:
First Name:ALDEA
Middle Name:POISSON
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ALDEA
Other - Last Name:VENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1870 CENTENNIAL DR APT 106
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-7499
Mailing Address - Country:US
Mailing Address - Phone:408-802-7084
Mailing Address - Fax:
Practice Address - Street 1:1870 CENTENNIAL DR APT 106
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-7499
Practice Address - Country:US
Practice Address - Phone:408-802-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician