Healthcare Provider Details

I. General information

NPI: 1104696392
Provider Name (Legal Business Name): KARL NICOLE MIQUELA LABRADOR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

1675 S MILPITAS BLVD APT 348
MILPITAS CA
95035-6698
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-1000
  • Fax:
Mailing address:
  • Phone: 347-805-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: