Healthcare Provider Details

I. General information

NPI: 1164267522
Provider Name (Legal Business Name): MYA LITTLEFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

IV. Provider business mailing address

PO BOX 15408
SAN LUIS OBISPO CA
93406-5408
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-6500
  • Fax: 805-540-6501
Mailing address:
  • Phone: 805-540-6500
  • Fax: 805-540-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-BYLUNJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: