Healthcare Provider Details

I. General information

NPI: 1073311684
Provider Name (Legal Business Name): MAYRA ALEJANDRA PRECIADO PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAYRA ALEJANDRA AGUILAR PPS

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 F ST
ANTIOCH CA
94509-2220
US

IV. Provider business mailing address

3509 RIO GRANDE DR
ANTIOCH CA
94509-5416
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7405
  • Fax:
Mailing address:
  • Phone: 925-305-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: