MEDICARE: MISS MICHELLE J MIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP15228	CA

General Provider Information

NPI Number	:	1508061011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE J MIN NP

Provider Business Mailing Address
First Line	:	11539 HAWTHORNE BLVD
Second Line	:	STE. 6E
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2325
Country	:	US
Telephone Number	:	310-531-2000
Fax Number	:	310-531-2084

Provider Business Practice Location Address
First Line	:	4314 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2808
Country	:	US
Telephone Number	:	310-531-2000
Fax Number	:	310-531-2084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	09/14/2021

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