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General NPI Number Information
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NPI Number | 1336466820
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Entity Type | Individual
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Provider Name | MIRICA ARTINE SANDERS D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 6995 WOODLANDS LN
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City | SOLON
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State | OH
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Zip | 44139-4664
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Country | US
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Telephone | 216-577-3441
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Fax |
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Provider Business Mailing Address
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Address Line | 6995 WOODLANDS LN
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City | SOLON
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State | OH
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Zip | 44139-4664
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Country | US
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Telephone | 216-372-5261
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | H0092696
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 91224
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34-010995
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License Number State | OH
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