Healthcare Provider Details

I. General information

NPI: 1922205566
Provider Name (Legal Business Name): DEBORAH S. MIORA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR SUITE 406
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR SUITE 406
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-8443
  • Fax: 310-306-1612
Mailing address:
  • Phone: 310-550-8443
  • Fax: 310-306-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY11599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: