Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP95010537 | CA |
NPI | 1003374075 |
---|---|
Provider Name | Mia Spinelli |
First Address | Long Beach, CA 90806-2775 |
Second Address | Long Beach, CA 90806-2775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2019 |
Last Update Date | 07/03/2019 |