Healthcare Provider Details

I. General information

NPI: 1831488097
Provider Name (Legal Business Name): JULIETA MIGUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S NEW HAMPSHIRE AVE
LOS ANGELES CA
90005-1831
US

IV. Provider business mailing address

2121 W TEMPLE ST
LOS ANGELES CA
90026-4915
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-5100
  • Fax: 213-252-5757
Mailing address:
  • Phone: 212-385-5100
  • Fax: 213-252-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-IWKLHB
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: