Provider Demographics
NPI:1841839222
Name:DALTON, MIRIAM J
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:J
Last Name:DALTON
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 1:2560 N PERRIS BLVD STE N1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3251
Mailing Address - Country:US
Mailing Address - Phone:951-940-6755
Mailing Address - Fax:
Practice Address - Street 1:2560 N PERRIS BLVD STE N1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3251
Practice Address - Country:US
Practice Address - Phone:951-940-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist