Basic Information
| Provider Information | |||||||||
| NPI: | 1679295125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRAMON MARTINEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | JESSICA | ||||||||
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| Credential: | SW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1942 FOUR IRON CT | ||||||||
| Address2: | |||||||||
| City: | FERNLEY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894086620 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 MILL ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755386700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2022 | ||||||||
| LastUpdateDate: | 09/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9615-M | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.