Healthcare Provider Details

I. General information

NPI: 1790304665
Provider Name (Legal Business Name): MICHAEL ANTHONY JAMES HOWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 SAN VICENTE BLVD STE 214
LOS ANGELES CA
90049-6513
US

IV. Provider business mailing address

11633 SAN VICENTE BLVD STE 214
LOS ANGELES CA
90049-6513
US

V. Phone/Fax

Practice location:
  • Phone: 310-979-8378
  • Fax:
Mailing address:
  • Phone: 310-979-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number59482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: