Provider Demographics
NPI:1598531261
Name:SEMPLE, MICHAELA BRYNN LAU
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:BRYNN LAU
Last Name:SEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:BRYNN
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24566 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2722
Mailing Address - Country:US
Mailing Address - Phone:971-832-4492
Mailing Address - Fax:
Practice Address - Street 1:24566 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2722
Practice Address - Country:US
Practice Address - Phone:971-832-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program