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General NPI Number Information
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NPI Number | 1922598119
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Entity Type | Individual
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Provider Name | CARLOS MIYASATO
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Gender | Male
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 550 W SAINT CHARLES RD
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City | ELMHURST
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State | IL
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Zip | 60126-3038
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Country | US
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Telephone | 815-469-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 730 CARPENTER AVE APT 2N
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City | OAK PARK
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State | IL
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Zip | 60304-1139
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-78664
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License Number State | IL
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