Most Relevant Information
Provider Data
| NPI Number: | 1003402082 |
| Provider Name: | MIA MARIE WYATT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/14/2020 |
| Last Updated: | 12/14/2020 |
Provider Practice Location
611 N BRAND BLVD
GLENDALE
CA
912031221
Practice Location Phone/Fax
| Phone: | 7472862600 |
| Fax: |
Provider Mailing Location
2092 SUMMIT AVE
ALTADENA
CA
910015720
Provider Mailing Phone/Fax
| Phone: | 6262146277 |
| Fax: |