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General NPI Number Information
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NPI Number | 1447918081
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Entity Type | Individual
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Provider Name | MIA WIGLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 8631 W 3RD ST STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90048-5901
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Country | US
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Telephone | 310-423-3277
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Fax |
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Provider Business Mailing Address
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Address Line | 8631 WEST 3RD STREET SUITE 240 EAST
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City | LOS ANGELES
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State | CA
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Zip | 90048
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Country | US
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Telephone | 310-423-3277
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 59229
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License Number State | CA
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