Provider Demographics
NPI:1104341387
Name:CARTAGENA, MIRELISE
Entity type:Individual
Prefix:DR
First Name:MIRELISE
Middle Name:
Last Name:CARTAGENA
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 1:3580 WILSHIRE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2533
Mailing Address - Country:US
Mailing Address - Phone:213-381-1250
Mailing Address - Fax:213-383-4803
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 137A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2549
Practice Address - Country:US
Practice Address - Phone:202-299-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-08-26
Deactivation Date:2021-03-31
Deactivation Code:
Reactivation Date:2021-04-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCPSY1001706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program