Provider Demographics
NPI:1396389789
Name:MIYA, LYNETTE MARIE (MN, RNP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MARIE
Last Name:MIYA
Suffix:
Gender:F
Credentials:MN, RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24266 WARD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6515
Mailing Address - Country:US
Mailing Address - Phone:310-561-3441
Mailing Address - Fax:310-542-8893
Practice Address - Street 1:20911 EARL ST STE 480
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4355
Practice Address - Country:US
Practice Address - Phone:310-370-7277
Practice Address - Fax:310-542-8893
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5143363LW0102X
CA377126363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health