Healthcare Provider Details

I. General information

NPI: 1073296505
Provider Name (Legal Business Name): MR. MIGUEL D. BOOKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 DELORA AVE
CLEVELAND OH
44144-4127
US

IV. Provider business mailing address

5320 DELORA AVE
CLEVELAND OH
44144-4127
US

V. Phone/Fax

Practice location:
  • Phone: 702-843-9829
  • Fax:
Mailing address:
  • Phone: 702-843-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: