Healthcare Provider Details

I. General information

NPI: 1801820527
Provider Name (Legal Business Name): BRIAN R MIURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOMITA BLVD
TORRANCE CA
90505-5102
US

IV. Provider business mailing address

2900 LOMITA BLVD
TORRANCE CA
90505-5102
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-3740
  • Fax:
Mailing address:
  • Phone: 310-283-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG80522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: