Healthcare Provider Details

I. General information

NPI: 1235421215
Provider Name (Legal Business Name): MS. MIIYOSHI ROGERS STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 S. COMPTON AVE.
LOS ANGELES CA
90001
US

IV. Provider business mailing address

1811 OAK ST STE 150
BAKERSFIELD CA
93301-3064
US

V. Phone/Fax

Practice location:
  • Phone: 323-586-7333
  • Fax: 310-965-9791
Mailing address:
  • Phone: 323-317-3743
  • Fax: 310-965-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: