MR. THEODORE JON MIRON (NPI# 1194946665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194946665 |
| Entity Type | Individual |
| Full Name | MR. THEODORE JON MIRON |
| Credential | PSY.S. |
| Practice Address |
3542 N 130th Dr Avondale AZ 85323-6681 |
| Practice Telephone | 6238778695 |
| Mailing Telephone | 6238778695 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
AZ | Behavioral Health & Social Service Providers |
| Street Address |
3542 N 130TH DR |
| City | AVONDALE |
| State | AZ |
| Zip Code | 85323-6681 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932663994 | Bridgewater Avondale Operations, LLC | Assisted Living Facility | 295 E Van Buren Street, Avondale, AZ 85323 | 2019-01-24 |
| 1104309152 | Carlos Sifuentes | Physical Therapist | 10750 W Mcdowell Rd., Ste. B-210, Avondale, AZ 85323 | 2018-09-14 |
| 1225534688 | Dayna Sue Kaepp | Registered Nurse | 3300 N. Santa Fe Trail, Avondale, AZ 85323 | 2018-04-04 |
| 1407376700 | Amanda Lynn Radcliffe | Nurse Practitioner | 824 N. 99th Ave Ste 108, Avondale, AZ 85323 | 2017-06-27 |
| 1093253361 | Aquatic-n-writing Rehad | Home Health | 12355 West Cocopah Street, Avondale, AZ 85323 | 2017-02-07 |
| 1750838348 | Annette A Alvarez | Specialist/Technologist | 295 W Western Avenue, Avondale, AZ 85323 | 2016-09-01 |
| 1649726886 | Michelle R Dotson | Contractor | 12115 W Van Buren St Apt 1924, Avondale, AZ 85323 | 2016-08-28 |
| 1619370756 | Amanda Mann | Physical Therapy Assistant | 12804 West Hildalgo, Avondale, AZ 85323 | 2014-10-03 |
| 1326459306 | Ma Caubalejo | Physical Therapist | 350 East La Canada Blvd, Avondale, AZ 85323 | 2014-05-13 |
| 1093139545 | Mark Salvador | Physical Therapy Assistant | 11722 W. Mountain View Dr., Avondale, AZ 85323 | 2014-02-04 |
| Find all providers in zip 85323 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306076526 | Stacy Anderson Taouil | Psychologist | 1406 N Central Ave, Avondale, AZ 85323-1312 | 2009-07-22 |
| 1285856302 | Mark Hedges | Psychologist | 10762 W Windsor Ave, Avondale, AZ 85323-5830 | 2007-05-02 |
| 1295956076 | Wendy Krisik | Psychologist | 11148 W Laurelwood Ln, Avondale, AZ 85323-3931 | 2007-05-01 |
| 1255483079 | Jim F Gorman | Psychologist | 530 East Riley Drive, Avondale, AZ 85323 | 2007-01-18 |
| 1356644405 | Sarah Opuroku | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2010-12-13 |
| 1235442724 | Shaunna Jean Sukey | Psychologist | 1406 N Central Ave, Avondale, AZ 85323-1312 | 2010-07-26 |
| 1083620561 | Stephen Clay Neal Jr. | Psychologist | 45 S 3rd Ave, Avondale, AZ 85323-2264 | 2006-08-01 |
| 1124032693 | Nancy R. Schaeffer | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-28 |
| 1124032131 | Jim Howard | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-27 |
| 1932113024 | Michael Harris Levine | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-27 |
| Find all providers in AVONDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.