Healthcare Provider Details

I. General information

NPI: 1528719804
Provider Name (Legal Business Name): MIA SUMMERS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 N HAYDEN RD STE H-113
SCOTTSDALE AZ
85260-5504
US

IV. Provider business mailing address

10603 N HAYDEN RD STE H-113 SCOTTSDALE MEDICAL ACUPUNCTURE
SCOTTSDALE AZ
85260-5504
US

V. Phone/Fax

Practice location:
  • Phone: 480-702-8657
  • Fax:
Mailing address:
  • Phone: 480-702-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-012208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: