Healthcare Provider Details

I. General information

NPI: 1174063739
Provider Name (Legal Business Name): ANA LAURA MISKULIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA LAURA MISKULIN

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 GALE AVE
CITY OF INDUSTRY CA
91748-1342
US

IV. Provider business mailing address

PO BOX 434
CORONA CA
92878-0434
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-0300
  • Fax:
Mailing address:
  • Phone: 714-869-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW70400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: