Healthcare Provider Details

I. General information

NPI: 1902417355
Provider Name (Legal Business Name): ARYANA CARVALHO-MIRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 415
LOS ANGELES CA
90064-1536
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 415
LOS ANGELES CA
90064-1536
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1845
  • Fax: 310-933-4803
Mailing address:
  • Phone: 424-225-1845
  • Fax: 310-933-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number298689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: