Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC26298 | CA |
Y | 213ER0200X | Radiology | DC26298 | CA |
NPI | 1376606335 |
---|---|
Provider Name | Joanne Louise Miceli |
First Address | Whittier, CA 90603-1058 |
Second Address | Montebello, CA 90640-5320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78181 | (02) | CA |