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General NPI Number Information
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NPI Number | 1518770874
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Entity Type | Organization
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Legal Business Name | MIGA, INC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 1338 CARLOTTA AVENUE
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City | BERKLEY
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State | CA
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Zip | 94703
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Country | US
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Telephone | 415-307-3302
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Fax |
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Provider Business Mailing Address
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Address Line | 68 HARRISON AVE STE 605
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City | BOSTON
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State | MA
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Zip | 02111-1929
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Country | US
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Telephone | 415-307-3302
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WALT COOPER
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Credential |
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Telephone | 719-466-1661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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