MEDICARE: LUCIA MIGUEL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D8624074	OTHER	CA	CALIFORNIA IDENTIFICATION CARD

General Provider Information

NPI Number	:	1730707985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA MIGUEL

Provider Business Mailing Address
First Line	:	1428 W 59TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1209
Country	:	US
Telephone Number	:	213-352-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 W 59TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1209
Country	:	US
Telephone Number	:	213-352-5528
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “ LUCIA MIGUEL ” Practice Location

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