Healthcare Provider Details

I. General information

NPI: 1326584764
Provider Name (Legal Business Name): MIKHAILA VINUYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-3579
US

IV. Provider business mailing address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

V. Phone/Fax

Practice location:
  • Phone: 818-739-5779
  • Fax:
Mailing address:
  • Phone: 818-993-9311
  • Fax: 323-232-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW93632
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number75793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: