Healthcare Provider Details

I. General information

NPI: 1265745160
Provider Name (Legal Business Name): MIA SUGI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE
LOS ANGELES CA
90027-6005
US

IV. Provider business mailing address

1300 N VERMONT AVE
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 213-913-4996
  • Fax:
Mailing address:
  • Phone: 213-913-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT32124
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: