Healthcare Provider Details

I. General information

NPI: 1487150736
Provider Name (Legal Business Name): CHRISTELLE MIOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST # 300
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11234 ANDERSON ST # MC1516B
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2395
  • Fax:
Mailing address:
  • Phone: 909-558-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number163775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: