Provider Demographics
NPI:1588224513
Name:INTENCION, MIKAELA
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:INTENCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20919 BLOOMFIELD AVE APT 64
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1842
Mailing Address - Country:US
Mailing Address - Phone:562-241-8260
Mailing Address - Fax:
Practice Address - Street 1:20919 BLOOMFIELD AVE APT 64
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1842
Practice Address - Country:US
Practice Address - Phone:562-241-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other