Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A52217 | CA |
NPI | 1619048691 |
---|---|
Provider Name | Alexander Miric |
First Address | Los Angeles, CA 90027-6021 |
Second Address | Los Angeles, CA 90027-6021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 30/11/2021 |