Provider Demographics
NPI:1871971853
Name:NINO, MIRIAM MINERVA (LICENSED LIFE COACH)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:MINERVA
Last Name:NINO
Suffix:
Gender:F
Credentials:LICENSED LIFE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 S CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1563
Mailing Address - Country:US
Mailing Address - Phone:619-409-9893
Mailing Address - Fax:
Practice Address - Street 1:1468 S CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1563
Practice Address - Country:US
Practice Address - Phone:619-409-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA069605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist