Provider Demographics
NPI:1548437817
Name:MIRELES, MARITZA (MA OT)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:MIRELES
Suffix:
Gender:F
Credentials:MA OT
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4525 VARSITY ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3863
Mailing Address - Country:US
Mailing Address - Phone:760-805-5617
Mailing Address - Fax:
Practice Address - Street 1:4562 WESTINGHOUSE ST STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5797
Practice Address - Country:US
Practice Address - Phone:805-644-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9487225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist