Healthcare Provider Details

I. General information

NPI: 1073292298
Provider Name (Legal Business Name): JANAE NICOLE MILEY STARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 4TH ST STE 120
SANTA ANA CA
92701-5143
US

IV. Provider business mailing address

1633 E 4TH ST STE 120
SANTA ANA CA
92701-5143
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-9266
  • Fax:
Mailing address:
  • Phone: 714-558-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: