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Individual

FLAVIA MYTILINEOS DE SOUZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4982 ST ALBERT DR, FONTANA, CA 92336-0657
(714) 676-6363
Mailing address
4982 ST ALBERT DR, FONTANA, CA 92336-0657
(714) 676-6363

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
175T00000X
Peer Specialist
Primary

Other

Enumeration date
07/26/2023
Last updated
01/22/2026
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