Doctor Name: | DR. SALVACION MIRAFUENTES LEE |
NPI Number: | 1700920147 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | A45616 |
Business Practice Address: | 11306 Ventura Blvd Studio City, CA - 916043137 |
Business Phone Number: | 8185051574 |
Business Fax Number: | 8185051574 |
Mailing Address: | 11306 Ventura Blvd, STUDIO CITY |
State: | CA |
Postal Code: | 916043137 |
Phone Number: | 8185051574 |
Fax Number: | 8185051574 |
NPI Enumeration Date: | 02/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A45616 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |