Provider Demographics
NPI:1881245975
Name:MINER, PHONPRAPHA SITHAVADY
Entity type:Individual
Prefix:MRS
First Name:PHONPRAPHA
Middle Name:SITHAVADY
Last Name:MINER
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 1:3171 VIA VIGANELLO
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-5305
Mailing Address - Country:US
Mailing Address - Phone:818-309-3330
Mailing Address - Fax:
Practice Address - Street 1:3171 VIA VIGANELLO
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-5305
Practice Address - Country:US
Practice Address - Phone:818-309-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB7087506OtherDRIVER LICENSE