Provider Demographics
NPI:1902841042
Name:MIYAKI, EDITH (RN, MS)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:
Last Name:MIYAKI
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:MS
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:BARNICA-BENITEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MS
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:1600 DIVISADERO ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-9692
Practice Address - Fax:415-353-7093
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541291363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner