Provider Demographics
NPI:1588103980
Name:PRIETO, MARIA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PRIETO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 COLINA DORADA DR
Mailing Address - Street 2:APT. #C102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2842
Mailing Address - Country:US
Mailing Address - Phone:805-294-0179
Mailing Address - Fax:
Practice Address - Street 1:11590 W BERNARDO CT
Practice Address - Street 2:SUITE #100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1622
Practice Address - Country:US
Practice Address - Phone:858-401-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst