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General NPI Number Information
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NPI Number | 1841492840
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Entity Type | Organization
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Legal Business Name | MIA BELLA PEDIATRICS
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26161 LA PAZ RD STE 115
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5317
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Country | US
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Telephone | 949-206-0001
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Fax | 949-206-0011
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Provider Business Mailing Address
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Address Line | 26161 LA PAZ RD STE 115
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5317
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Country | US
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Telephone | 949-206-0001
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Fax | 949-206-0011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZANNE LYNN MCNULTY
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Credential | M.D.
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Telephone | 949-206-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A74237
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License Number State | NE
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