Provider Demographics
NPI:1841492840
Name:MIA BELLA PEDIATRICS
Entity type:Organization
Organization Name:MIA BELLA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-206-0001
Mailing Address - Street 1:26161 LA PAZ RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5317
Mailing Address - Country:US
Mailing Address - Phone:949-206-0001
Mailing Address - Fax:949-206-0011
Practice Address - Street 1:26161 LA PAZ RD STE 115
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5317
Practice Address - Country:US
Practice Address - Phone:949-206-0001
Practice Address - Fax:949-206-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEA74237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty