Provider Demographics
NPI:1447446604
Name:CONTRERAS, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CONTRERAS
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 1:6848 MAGNOLIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2858
Mailing Address - Country:US
Mailing Address - Phone:951-341-8833
Mailing Address - Fax:951-682-2561
Practice Address - Street 1:6848 MAGNOLIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2858
Practice Address - Country:US
Practice Address - Phone:951-341-8833
Practice Address - Fax:951-682-2561
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4100205810OtherMENTAL HEALTH