Provider Demographics
NPI:1528524741
Name:MYLES, ZURI DALILA (BA)
Entity type:Individual
Prefix:MRS
First Name:ZURI
Middle Name:DALILA
Last Name:MYLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:ZURI
Other - Middle Name:DALILA
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:3407 BOWFIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:562-209-3652
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1612
Practice Address - Country:US
Practice Address - Phone:714-879-2274
Practice Address - Fax:714-879-2274
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician