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General NPI Number Information
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NPI Number | 1326108895
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Entity Type | Individual
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Provider Name | MIRYAM SUSANA MIYAMOTO MD, DDS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 23333 CINEMA DR SUITE #200
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City | VALENCIA
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State | CA
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Zip | 91355-5432
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Country | US
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Telephone | 661-254-6464
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Fax | 661-254-8367
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Provider Business Mailing Address
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Address Line | 23333 CINEMA DR SUITE #200
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City | VALENCIA
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State | CA
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Zip | 91355-5432
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Country | US
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Telephone | 661-254-6464
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Fax | 661-254-8367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 37141
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License Number State | CA
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