Healthcare Provider Details

I. General information

NPI: 1184208308
Provider Name (Legal Business Name): MYRA JEANNETTE ARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43979 15TH ST W
LANCASTER CA
93534-4635
US

IV. Provider business mailing address

43979 15TH ST W
LANCASTER CA
93534-4635
US

V. Phone/Fax

Practice location:
  • Phone: 661-522-3711
  • Fax: 661-522-3714
Mailing address:
  • Phone: 661-522-3711
  • Fax: 661-522-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number07721524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: