Healthcare Provider Details

I. General information

NPI: 1831649144
Provider Name (Legal Business Name): MIA GAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

IV. Provider business mailing address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

V. Phone/Fax

Practice location:
  • Phone: 415-840-0560
  • Fax:
Mailing address:
  • Phone: 415-840-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58196
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063329
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: