Healthcare Provider Details

I. General information

NPI: 1699400267
Provider Name (Legal Business Name): MISS MAE LIAN MISSANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 N PASS AVE STE D
BURBANK CA
91505-3877
US

IV. Provider business mailing address

353 N PASS AVE
BURBANK CA
91505-3883
US

V. Phone/Fax

Practice location:
  • Phone: 818-482-2273
  • Fax:
Mailing address:
  • Phone: 818-482-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: