Healthcare Provider Details

I. General information

NPI: 1801645411
Provider Name (Legal Business Name): CLAIRE MINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 HACIENDA DR
VISTA CA
92081-4542
US

IV. Provider business mailing address

1011 PRISCILLA LN
ALEXANDRIA VA
22308-2646
US

V. Phone/Fax

Practice location:
  • Phone: 619-493-0077
  • Fax:
Mailing address:
  • Phone: 215-534-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83227
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: