Provider Demographics
NPI:1316509813
Name:PRIETO, SHANAE A
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:A
Last Name:PRIETO
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 1:13602 PENN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1837
Mailing Address - Country:US
Mailing Address - Phone:562-332-7521
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3168
Practice Address - Country:US
Practice Address - Phone:562-698-6613
Practice Address - Fax:562-698-6613
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician