Provider Demographics
NPI:1982140877
Name:MIRAMONTES, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MIRAMONTES
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 1:1180 THIRD AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3139
Mailing Address - Country:US
Mailing Address - Phone:619-691-8164
Mailing Address - Fax:619-426-2359
Practice Address - Street 1:7545 METROPOLITAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4402
Practice Address - Country:US
Practice Address - Phone:619-718-9890
Practice Address - Fax:619-718-9897
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1238191216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)