Healthcare Provider Details

I. General information

NPI: 1205164068
Provider Name (Legal Business Name): PAMELA MIURA L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 SEPULVEDA BLVD
SHERMAN OAKS CA
91411-3437
US

IV. Provider business mailing address

4110 EAST BLVD
LOS ANGELES CA
90066-4610
US

V. Phone/Fax

Practice location:
  • Phone: 818-988-7988
  • Fax: 818-988-7588
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: